Provider Demographics
NPI:1396340386
Name:GERNUX, ELIZABETH JANE
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JANE
Last Name:GERNUX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-2822
Mailing Address - Country:US
Mailing Address - Phone:203-723-1172
Mailing Address - Fax:203-723-0643
Practice Address - Street 1:98 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-2822
Practice Address - Country:US
Practice Address - Phone:203-723-1172
Practice Address - Fax:203-723-0643
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14582183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist