Provider Demographics
NPI:1659654291
Name:WOODRUFF, DEAN MICHAEL (RPH)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:MICHAEL
Last Name:WOODRUFF
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 STRAWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-3905
Mailing Address - Country:US
Mailing Address - Phone:860-628-4729
Mailing Address - Fax:
Practice Address - Street 1:649 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-1082
Practice Address - Country:US
Practice Address - Phone:203-757-6010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6634183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist