Provider Demographics
NPI:1740661990
Name:ZAETS, ROMAN I (PHARMD)
Entity type:Individual
Prefix:MR
First Name:ROMAN
Middle Name:
Last Name:ZAETS
Suffix:I
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3304
Mailing Address - Country:US
Mailing Address - Phone:203-777-7248
Mailing Address - Fax:203-777-2722
Practice Address - Street 1:66 CHURCH ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3304
Practice Address - Country:US
Practice Address - Phone:203-777-7248
Practice Address - Fax:203-777-2722
Is Sole Proprietor?:No
Enumeration Date:2015-06-13
Last Update Date:2015-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0013081183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist