Provider Demographics
NPI:1639480163
Name:KOIVISTO, CATHERINE ANN (RPH)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANN
Last Name:KOIVISTO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 FOX HILL RD
Mailing Address - Street 2:
Mailing Address - City:POMFRET CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06259-1134
Mailing Address - Country:US
Mailing Address - Phone:860-928-6034
Mailing Address - Fax:860-963-7951
Practice Address - Street 1:1 ANNIE GEORGE DR
Practice Address - Street 2:
Practice Address - City:MASHANTUCKET
Practice Address - State:CT
Practice Address - Zip Code:06338-3801
Practice Address - Country:US
Practice Address - Phone:888-779-6362
Practice Address - Fax:800-779-6329
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI3994183500000X
CTCT9619183500000X
MA27765183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist