Provider Demographics
NPI:1205298312
Name:OHEARN, ALISON
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:OHEARN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 BUCKLEY HWY
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:CT
Mailing Address - Zip Code:06076-4905
Mailing Address - Country:US
Mailing Address - Phone:860-684-4877
Mailing Address - Fax:
Practice Address - Street 1:3514 MAIN ST
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:CT
Practice Address - Zip Code:06238-1551
Practice Address - Country:US
Practice Address - Phone:860-742-3543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11298183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist