Provider Demographics
NPI:1689713422
Name:LOVELAND, JOHN ROBERT (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ROBERT
Last Name:LOVELAND
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 1:543 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-3915
Mailing Address - Country:US
Mailing Address - Phone:860-225-6487
Mailing Address - Fax:860-229-4488
Practice Address - Street 1:543 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-3915
Practice Address - Country:US
Practice Address - Phone:860-225-6487
Practice Address - Fax:860-229-4488
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6770183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT6770OtherPHARMACIST LICENSE NUM