Provider Demographics
NPI:1982119715
Name:MURDANDE, VINU SHARAD
Entity Type:Individual
Prefix:
First Name:VINU
Middle Name:SHARAD
Last Name:MURDANDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 GOLD STAR HWY
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-3442
Mailing Address - Country:US
Mailing Address - Phone:860-449-6902
Mailing Address - Fax:
Practice Address - Street 1:150 GOLD STAR HWY
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-3442
Practice Address - Country:US
Practice Address - Phone:860-449-6902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT0010726183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist