Provider Demographics
NPI:1538471586
Name:KRASNICKI, DERREK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DERREK
Middle Name:
Last Name:KRASNICKI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 PALMETTO TRL
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-4631
Mailing Address - Country:US
Mailing Address - Phone:203-691-6508
Mailing Address - Fax:
Practice Address - Street 1:31 PALMETTO TRL
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512-4631
Practice Address - Country:US
Practice Address - Phone:203-691-6508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT0010746183500000X
NY051743-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist