Provider Demographics
NPI:1730638743
Name:STRZEGOWSKI, LANCE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:STRZEGOWSKI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CONCORD DR
Mailing Address - Street 2:
Mailing Address - City:EAST GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06026-9507
Mailing Address - Country:US
Mailing Address - Phone:860-490-0205
Mailing Address - Fax:
Practice Address - Street 1:5 CONCORD DR
Practice Address - Street 2:
Practice Address - City:EAST GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06026-9507
Practice Address - Country:US
Practice Address - Phone:860-490-0205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT22336183500000X
MA8650183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist