Provider Demographics
NPI:1629540703
Name:ARUNDEL, DORIS LOUISE
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:LOUISE
Last Name:ARUNDEL
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 1:57 PROVIDENCE PIKE
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-2413
Mailing Address - Country:US
Mailing Address - Phone:860-963-2548
Mailing Address - Fax:860-963-2597
Practice Address - Street 1:57 PROVIDENCE PIKE
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-2413
Practice Address - Country:US
Practice Address - Phone:860-963-2548
Practice Address - Fax:860-963-2597
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-29
Last Update Date:2018-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8229183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist