Provider Demographics
NPI:1861853764
Name:MANFERDINI, DAWN (PHARMD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:MANFERDINI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-2834
Mailing Address - Country:US
Mailing Address - Phone:860-536-5635
Mailing Address - Fax:860-536-7492
Practice Address - Street 1:25 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-2834
Practice Address - Country:US
Practice Address - Phone:860-536-5635
Practice Address - Fax:860-536-7492
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-19
Last Update Date:2016-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0012311183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist