Provider Demographics
NPI:1285144063
Name:STANTON, BRENT PATRICK (PHARMD)
Entity type:Individual
Prefix:MR
First Name:BRENT
Middle Name:PATRICK
Last Name:STANTON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 WAUREGAN RD
Mailing Address - Street 2:
Mailing Address - City:DANIELSON
Mailing Address - State:CT
Mailing Address - Zip Code:06239-3712
Mailing Address - Country:US
Mailing Address - Phone:860-774-7437
Mailing Address - Fax:
Practice Address - Street 1:70 WAUREGAN RD
Practice Address - Street 2:
Practice Address - City:DANIELSON
Practice Address - State:CT
Practice Address - Zip Code:06239-3712
Practice Address - Country:US
Practice Address - Phone:860-774-7437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0013871183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist