Provider Demographics
NPI:1700315793
Name:MARCINIAK, MICHELE (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:MARCINIAK
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413-2200
Mailing Address - Country:US
Mailing Address - Phone:860-669-6636
Mailing Address - Fax:860-664-9315
Practice Address - Street 1:215 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:CT
Practice Address - Zip Code:06413-2200
Practice Address - Country:US
Practice Address - Phone:860-669-6636
Practice Address - Fax:860-664-9315
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6819183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist