Provider Demographics
NPI:1790807014
Name:SOJA, DEANNA MARIE (RPH CDM)
Entity Type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:MARIE
Last Name:SOJA
Suffix:
Gender:F
Credentials:RPH CDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ASHFORD DR
Mailing Address - Street 2:
Mailing Address - City:ASHFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06278-1902
Mailing Address - Country:US
Mailing Address - Phone:860-487-8708
Mailing Address - Fax:860-684-5082
Practice Address - Street 1:87 W STAFFORD RD STE C
Practice Address - Street 2:
Practice Address - City:STAFFORD SPRINGS
Practice Address - State:CT
Practice Address - Zip Code:06076-1044
Practice Address - Country:US
Practice Address - Phone:860-684-4597
Practice Address - Fax:860-684-5082
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8119183500000X
MA22738183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist