Provider Demographics
NPI:1841602059
Name:CHUCKTA, LORI (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:
Last Name:CHUCKTA
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 1:37 NEW HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483-3460
Mailing Address - Country:US
Mailing Address - Phone:203-888-0073
Mailing Address - Fax:203-888-2932
Practice Address - Street 1:37 NEW HAVEN RD
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:CT
Practice Address - Zip Code:06483-3460
Practice Address - Country:US
Practice Address - Phone:203-888-0073
Practice Address - Fax:203-888-2932
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6397183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT413949OtherNABP