Provider Demographics
NPI:1063708840
Name:FALCONER, CARLENE
Entity type:Individual
Prefix:
First Name:CARLENE
Middle Name:
Last Name:FALCONER
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 1:271 ELLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-1129
Mailing Address - Country:US
Mailing Address - Phone:860-528-6114
Mailing Address - Fax:
Practice Address - Street 1:271 ELLINGTON RD
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-1129
Practice Address - Country:US
Practice Address - Phone:860-528-6115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5744183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist