Provider Demographics
NPI:1558169946
Name:BLACKWOOD, TEONIA (RPH)
Entity type:Individual
Prefix:
First Name:TEONIA
Middle Name:
Last Name:BLACKWOOD
Suffix:
Gender:
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06114-2207
Mailing Address - Country:US
Mailing Address - Phone:860-790-9750
Mailing Address - Fax:
Practice Address - Street 1:484 WINDSOR AVE
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-4401
Practice Address - Country:US
Practice Address - Phone:860-947-5078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0016872183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist