Provider Demographics
NPI:1780190579
Name:NAIK, MADHURA
Entity Type:Individual
Prefix:
First Name:MADHURA
Middle Name:
Last Name:NAIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 BUCKLAND HILLS DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-8755
Mailing Address - Country:US
Mailing Address - Phone:860-644-5105
Mailing Address - Fax:860-644-4164
Practice Address - Street 1:420 BUCKLAND HILLS DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-8755
Practice Address - Country:US
Practice Address - Phone:860-644-5105
Practice Address - Fax:860-644-4164
Is Sole Proprietor?:No
Enumeration Date:2017-12-16
Last Update Date:2017-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0011366183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist