Provider Demographics
NPI:1154824639
Name:VONDERHEYDE, ROBYN LYNN (PHARMD)
Entity type:Individual
Prefix:
First Name:ROBYN
Middle Name:LYNN
Last Name:VONDERHEYDE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ROBYN
Other - Middle Name:LYNN
Other - Last Name:PISACANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:38 PRINDLE DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3744
Mailing Address - Country:US
Mailing Address - Phone:203-804-4935
Mailing Address - Fax:
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-688-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0012589183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist