Provider Demographics
NPI:1558650853
Name:PELLETIER, HENRY LOUIS JR (RPH)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:LOUIS
Last Name:PELLETIER
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 MOODY RD
Mailing Address - Street 2:AHF PHARMACY
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-3101
Mailing Address - Country:US
Mailing Address - Phone:800-243-4621
Mailing Address - Fax:860-763-7022
Practice Address - Street 1:31 MOODY RD
Practice Address - Street 2:AHF PHARMACY
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3101
Practice Address - Country:US
Practice Address - Phone:800-243-4621
Practice Address - Fax:860-763-7022
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007499183500000X
MA15436183500000X
MEPR6377183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist