Provider Demographics
NPI:1760903884
Name:LEVY, CONNIE SUSANNA (PHARMD)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:SUSANNA
Last Name:LEVY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5930 SPENCER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-1912
Mailing Address - Country:US
Mailing Address - Phone:914-420-0783
Mailing Address - Fax:
Practice Address - Street 1:190 EAST AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06855-1112
Practice Address - Country:US
Practice Address - Phone:203-838-6141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0014002183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist