Provider Demographics
NPI:1245723733
Name:STRAIT, WILLIAM CARROLL JR (RPH)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CARROLL
Last Name:STRAIT
Suffix:JR
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 1:162 STILL RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2272
Mailing Address - Country:US
Mailing Address - Phone:860-286-9202
Mailing Address - Fax:
Practice Address - Street 1:1095 KENNEDY RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-1339
Practice Address - Country:US
Practice Address - Phone:860-688-1744
Practice Address - Fax:860-687-1855
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0007262183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist