Provider Demographics
NPI:1265936009
Name:MORASUTTI, COSTANTE JOHN (RPH)
Entity type:Individual
Prefix:
First Name:COSTANTE
Middle Name:JOHN
Last Name:MORASUTTI
Suffix:
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 1:905 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-3418
Mailing Address - Country:US
Mailing Address - Phone:203-272-3255
Mailing Address - Fax:203-699-9345
Practice Address - Street 1:905 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-3418
Practice Address - Country:US
Practice Address - Phone:203-272-3255
Practice Address - Fax:203-699-9345
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5342183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT5342OtherPHARMACIST LICENSE NUMBER STATE OF CT
CT5342OtherSTATE OF CONNECTICUT DEPARTMENT CONSUMER PROTECTION