Provider Demographics
NPI:1912597055
Name:GARGANO, RONALD RALPH
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:RALPH
Last Name:GARGANO
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 1:60 LAUREL HILL RD
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-2408
Mailing Address - Country:US
Mailing Address - Phone:203-641-3102
Mailing Address - Fax:203-488-4078
Practice Address - Street 1:581 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2205
Practice Address - Country:US
Practice Address - Phone:203-250-2251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4791183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist