Provider Demographics
NPI:1659654994
Name:OUELLETTE, TIMOTHY (RPH)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:OUELLETTE
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 1:867 W POND MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06498-2836
Mailing Address - Country:US
Mailing Address - Phone:860-339-5447
Mailing Address - Fax:
Practice Address - Street 1:867 W POND MEADOW RD
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:CT
Practice Address - Zip Code:06498-2836
Practice Address - Country:US
Practice Address - Phone:860-339-5447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9478183500000X
RI04208183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist