Provider Demographics
NPI:1598317422
Name:LAFORD, ALLISA I
Entity Type:Individual
Prefix:
First Name:ALLISA
Middle Name:
Last Name:LAFORD
Suffix:I
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 1:26 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:DANIELSON
Mailing Address - State:CT
Mailing Address - Zip Code:06239-2617
Mailing Address - Country:US
Mailing Address - Phone:860-315-0471
Mailing Address - Fax:
Practice Address - Street 1:140 N FRONTAGE ROAD
Practice Address - Street 2:WITHIN UNITED SERVICES INC. ROOM 171
Practice Address - City:MANSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06250-0625
Practice Address - Country:US
Practice Address - Phone:860-455-4245
Practice Address - Fax:860-757-5885
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0014126183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist