Provider Demographics
NPI:1801162946
Name:SVOBODA, DENISE JACQUES (RPH)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:JACQUES
Last Name:SVOBODA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4555
Mailing Address - Country:US
Mailing Address - Phone:860-346-1779
Mailing Address - Fax:
Practice Address - Street 1:416 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4555
Practice Address - Country:US
Practice Address - Phone:860-346-1779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0007568183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist