Provider Demographics
NPI:1689773970
Name:FLYNN, COLLEEN ROSE (RPH)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:ROSE
Last Name:FLYNN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 WARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-3049
Mailing Address - Country:US
Mailing Address - Phone:860-559-0911
Mailing Address - Fax:860-667-6752
Practice Address - Street 1:555 WILLARD AVE
Practice Address - Street 2:VACT HEALTHCARE SYSTEM PHARMACY
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2631
Practice Address - Country:US
Practice Address - Phone:860-594-6356
Practice Address - Fax:860-667-6752
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6374183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist