Provider Demographics
NPI:1194496455
Name:GOLEBIEWSKI, KATHLEEN
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:GOLEBIEWSKI
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 1:91 OLD MUSKET DR
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-3430
Mailing Address - Country:US
Mailing Address - Phone:860-841-9928
Mailing Address - Fax:
Practice Address - Street 1:26 WATERBURY RD
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:CT
Practice Address - Zip Code:06712-1215
Practice Address - Country:US
Practice Address - Phone:203-758-3316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-25
Last Update Date:2024-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT0014872183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist