Provider Demographics
NPI:1639572936
Name:MAZHANDU, FARAI
Entity Type:Individual
Prefix:
First Name:FARAI
Middle Name:
Last Name:MAZHANDU
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 1:47 SCHOOL ST APT 1W
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-3314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1492 HIGHLAND AVE
Practice Address - Street 2:SUITE 1C
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-1287
Practice Address - Country:US
Practice Address - Phone:203-439-9099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0013139183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist