Provider Demographics
NPI:1558973974
Name:PAUL-KARDOS, STACY ELAINE
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:ELAINE
Last Name:PAUL-KARDOS
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 1:14 OLD MEADOW PLAIN RD
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-2710
Mailing Address - Country:US
Mailing Address - Phone:860-944-2455
Mailing Address - Fax:
Practice Address - Street 1:4 HAMMERHEAD PL
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-1805
Practice Address - Country:US
Practice Address - Phone:860-613-2324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5857183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist