Provider Demographics
NPI:1881984482
Name:SANTA, FREDERICK J JR (RPH)
Entity type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:J
Last Name:SANTA
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
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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
Mailing Address - Country:US
Mailing Address - Phone:203-777-7248
Mailing Address - Fax:203-777-2722
Practice Address - Street 1:445 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-1320
Practice Address - Country:US
Practice Address - Phone:203-287-7375
Practice Address - Fax:203-287-7376
Is Sole Proprietor?:No
Enumeration Date:2011-04-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5171183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist