Provider Demographics
NPI:1033603394
Name:DE GUZMAN, JAN CRISTOPHER HERNANDEZ (PHARMD, MSF, RPH)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:CRISTOPHER HERNANDEZ
Last Name:DE GUZMAN
Suffix:
Gender:M
Credentials:PHARMD, MSF, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 STEVENS ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-3852
Mailing Address - Country:US
Mailing Address - Phone:203-852-2690
Mailing Address - Fax:203-899-5079
Practice Address - Street 1:24 STEVENS ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3852
Practice Address - Country:US
Practice Address - Phone:203-852-2690
Practice Address - Fax:203-899-5079
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0014232183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist