Provider Demographics
NPI:1881814556
Name:PERROTTI, SUSAN PAMELA (RPH)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:PAMELA
Last Name:PERROTTI
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 1:127 CAMBRIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-5200
Mailing Address - Country:US
Mailing Address - Phone:860-666-3141
Mailing Address - Fax:
Practice Address - Street 1:976 1/2-978 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107
Practice Address - Country:US
Practice Address - Phone:860-521-5844
Practice Address - Fax:860-521-5003
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4334183500000X
NJ28RI01254600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist