Provider Demographics
NPI:1013293851
Name:THEIS, ALEC (PHARMD)
Entity type:Individual
Prefix:
First Name:ALEC
Middle Name:
Last Name:THEIS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3265 BERLIN TPKE
Mailing Address - Street 2:T1802
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-5101
Mailing Address - Country:US
Mailing Address - Phone:860-616-0023
Mailing Address - Fax:860-616-2487
Practice Address - Street 1:3265 BERLIN TPKE
Practice Address - Street 2:T1802
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-5101
Practice Address - Country:US
Practice Address - Phone:860-616-0023
Practice Address - Fax:860-616-2487
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00101221835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy