Provider Demographics
NPI:1265415673
Name:UPDYKE, DEBRA L (RPH)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:L
Last Name:UPDYKE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:DEBRA
Other - Middle Name:L
Other - Last Name:UPDYKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1289 FOXON RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06471-1289
Mailing Address - Country:US
Mailing Address - Phone:203-484-9681
Mailing Address - Fax:203-484-9530
Practice Address - Street 1:266 E MAIN ST
Practice Address - Street 2:SHOPRITE PHARMACY
Practice Address - City:CLINTON
Practice Address - State:CT
Practice Address - Zip Code:06413
Practice Address - Country:US
Practice Address - Phone:860-669-6619
Practice Address - Fax:203-484-9530
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT08446183500000X
IN15443183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist