Provider Demographics
NPI:1831478858
Name:CYGANOSKI, CHARLES JOSEPH JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JOSEPH
Last Name:CYGANOSKI
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:MOOSUP
Mailing Address - State:CT
Mailing Address - Zip Code:06354-1425
Mailing Address - Country:US
Mailing Address - Phone:860-564-5871
Mailing Address - Fax:860-564-0209
Practice Address - Street 1:20 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:MOOSUP
Practice Address - State:CT
Practice Address - Zip Code:06354-1425
Practice Address - Country:US
Practice Address - Phone:860-564-5871
Practice Address - Fax:860-564-0209
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0009423183500000X
RIRPH02285183500000X
FLPS22633183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist