Provider Demographics
NPI:1942583679
Name:TINGLEY, ERIC A (RPH)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:A
Last Name:TINGLEY
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 1:42 RESERVOIR RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:CT
Mailing Address - Zip Code:06249-2717
Mailing Address - Country:US
Mailing Address - Phone:860-334-3695
Mailing Address - Fax:
Practice Address - Street 1:399 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-5414
Practice Address - Country:US
Practice Address - Phone:860-885-0389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10011183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist