Provider Demographics
NPI:1245838721
Name:RETTIG, ELIZABETH (RPH)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:RETTIG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 TRIPP HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:CT
Mailing Address - Zip Code:06234-2321
Mailing Address - Country:US
Mailing Address - Phone:860-455-8720
Mailing Address - Fax:
Practice Address - Street 1:1197 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-1907
Practice Address - Country:US
Practice Address - Phone:860-423-1661
Practice Address - Fax:860-423-1200
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT0009319183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist