Provider Demographics
NPI:1811016694
Name:CROSS, NADINE DEBRA-ANN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:NADINE
Middle Name:DEBRA-ANN
Last Name:CROSS
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 1:392 MILE HILL RD
Mailing Address - Street 2:
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-3605
Mailing Address - Country:US
Mailing Address - Phone:860-870-4778
Mailing Address - Fax:860-870-4778
Practice Address - Street 1:410 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002
Practice Address - Country:US
Practice Address - Phone:860-286-9177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT08481183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT08481OtherREGISTERED PHARMACIST