Provider Demographics
NPI:1851566426
Name:BRODY, WENDY ROCCISANO (RPH)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:ROCCISANO
Last Name:BRODY
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 1:203 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1628
Mailing Address - Country:US
Mailing Address - Phone:860-963-7230
Mailing Address - Fax:860-928-6298
Practice Address - Street 1:203 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1628
Practice Address - Country:US
Practice Address - Phone:860-963-7230
Practice Address - Fax:860-928-6298
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8997183500000X
MA24236183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist