Provider Demographics
NPI:1942579495
Name:ESSENTER, BRIAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:ESSENTER
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 1:197 ALLERTON RD
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-1624
Mailing Address - Country:US
Mailing Address - Phone:203-225-0296
Mailing Address - Fax:203-225-0309
Practice Address - Street 1:700 BRIDGEPORT AVE
Practice Address - Street 2:101
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4734
Practice Address - Country:US
Practice Address - Phone:203-225-0296
Practice Address - Fax:203-225-0309
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0010683183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist