Provider Demographics
NPI:1821381690
Name:RESCILDO, RAYMOND J (RPH)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:J
Last Name:RESCILDO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 WOLCOTT RD
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716-1906
Mailing Address - Country:US
Mailing Address - Phone:203-879-5853
Mailing Address - Fax:203-879-6609
Practice Address - Street 1:744 WOLCOTT RD
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:CT
Practice Address - Zip Code:06716-1906
Practice Address - Country:US
Practice Address - Phone:203-879-5853
Practice Address - Fax:203-879-6609
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0004931183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist