Provider Demographics
NPI:1124506233
Name:JATTAN, JAVEED
Entity type:Individual
Prefix:
First Name:JAVEED
Middle Name:
Last Name:JATTAN
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 1:101 SOUTH ST APT 44
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4480
Mailing Address - Country:US
Mailing Address - Phone:910-364-6110
Mailing Address - Fax:
Practice Address - Street 1:20 CONNECTICUT BLVD
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-3007
Practice Address - Country:US
Practice Address - Phone:860-289-4944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25006183500000X
CTPCT.0013994183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist