Provider Demographics
NPI:1538653910
Name:LUCERTINI, KRISTINE L
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:L
Last Name:LUCERTINI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 LEETES ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-6514
Mailing Address - Country:US
Mailing Address - Phone:203-481-3392
Mailing Address - Fax:
Practice Address - Street 1:4 WELLESLEY DR
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3266
Practice Address - Country:US
Practice Address - Phone:203-996-6552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8751183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist