Provider Demographics
NPI:1720512874
Name:RACCUIA, DANIEL SETH
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:SETH
Last Name:RACCUIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 MONROE TPKE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-2382
Mailing Address - Country:US
Mailing Address - Phone:203-261-1185
Mailing Address - Fax:203-445-0179
Practice Address - Street 1:535 MONROE TPKE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-2382
Practice Address - Country:US
Practice Address - Phone:203-261-1185
Practice Address - Fax:203-445-0179
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-16
Last Update Date:2017-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0013688183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist