Provider Demographics
NPI:1285456335
Name:GUERRERA, SOPHIA ROSE (PHARMD)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:ROSE
Last Name:GUERRERA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 JASON AVE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-2746
Mailing Address - Country:US
Mailing Address - Phone:860-483-1352
Mailing Address - Fax:
Practice Address - Street 1:747 PINE ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-6959
Practice Address - Country:US
Practice Address - Phone:860-583-9213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0016739183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist