Provider Demographics
NPI:1821135328
Name:SPOSATO, PETER J (RPH, BCNP)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:J
Last Name:SPOSATO
Suffix:
Gender:M
Credentials:RPH, BCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 DEER RUN DR
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06415-1806
Mailing Address - Country:US
Mailing Address - Phone:860-328-5927
Mailing Address - Fax:
Practice Address - Street 1:35 DEER RUN DR
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415-1806
Practice Address - Country:US
Practice Address - Phone:860-328-5927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT79491835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N0905XPharmacy Service ProvidersPharmacistNuclear