Provider Demographics
NPI:1649008913
Name:STATE OF CONNECTICUT
Entity type:Organization
Organization Name:STATE OF CONNECTICUT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:REIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-679-3692
Mailing Address - Street 1:263 FARMINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-2205
Mailing Address - Country:US
Mailing Address - Phone:860-679-2281
Mailing Address - Fax:860-679-1231
Practice Address - Street 1:263 FARMINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-2205
Practice Address - Country:US
Practice Address - Phone:860-679-2281
Practice Address - Fax:860-679-1231
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UCONN HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy