Provider Demographics
NPI:1245513357
Name:ROSA, KRZYSZTOF (PHARMD)
Entity type:Individual
Prefix:
First Name:KRZYSZTOF
Middle Name:
Last Name:ROSA
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 1:20 BROAD PL
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-7011
Mailing Address - Country:US
Mailing Address - Phone:860-406-1770
Mailing Address - Fax:
Practice Address - Street 1:102 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-1826
Practice Address - Country:US
Practice Address - Phone:860-826-7272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-25
Last Update Date:2011-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0011038183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist