Provider Demographics
NPI:1952837726
Name:CRESPO, LAUREN ROSELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ROSELLE
Last Name:CRESPO
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 1:210 PINE ST
Mailing Address - Street 2:APT. 103
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-8400
Mailing Address - Country:US
Mailing Address - Phone:516-417-7117
Mailing Address - Fax:
Practice Address - Street 1:10 PITKIN RD
Practice Address - Street 2:10 PITKIN ROAD
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4709
Practice Address - Country:US
Practice Address - Phone:860-871-1150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0013684183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist