Provider Demographics
NPI:1295245959
Name:MEADOWS, GARTH ERIC (RPH)
Entity type:Individual
Prefix:
First Name:GARTH
Middle Name:ERIC
Last Name:MEADOWS
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 1:22 SPENCER PLAIN RD
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-4000
Mailing Address - Country:US
Mailing Address - Phone:860-395-0515
Mailing Address - Fax:844-206-7541
Practice Address - Street 1:22 SPENCER PLAIN RD
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-4000
Practice Address - Country:US
Practice Address - Phone:860-395-0515
Practice Address - Fax:844-206-7541
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6226183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist