Provider Demographics
NPI:1639648967
Name:SYMOCHKO, PETER NIKOLAI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:NIKOLAI
Last Name:SYMOCHKO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 OLD ZOAR RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-1483
Mailing Address - Country:US
Mailing Address - Phone:203-615-8698
Mailing Address - Fax:
Practice Address - Street 1:700 BRIDGEPORT AVE STE 101
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4734
Practice Address - Country:US
Practice Address - Phone:203-225-0296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0014559183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist