Provider Demographics
NPI:1063170322
Name:SACRO, KATHRYN (PHARMD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:SACRO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:STECKOWYCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:281 EASTBURY HILL RD
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-3940
Mailing Address - Country:US
Mailing Address - Phone:603-498-1256
Mailing Address - Fax:
Practice Address - Street 1:55 PARK ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5474
Practice Address - Country:US
Practice Address - Phone:475-246-9956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.00136831835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory CareGroup - Single Specialty