Provider Demographics
NPI:1679066252
Name:MISTRY, MONICABEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MONICABEN
Middle Name:
Last Name:MISTRY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:MISTRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:185 MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029-4311
Mailing Address - Country:US
Mailing Address - Phone:229-256-8464
Mailing Address - Fax:
Practice Address - Street 1:10 PITKIN RD
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4718
Practice Address - Country:US
Practice Address - Phone:860-871-1053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-08
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT0014163183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist