Provider Demographics
NPI:1316260284
Name:PAINE, THERESA F (PHARMD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:F
Last Name:PAINE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:THERESA
Other - Middle Name:F
Other - Last Name:FAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:39 COLBURN RD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD SPRINGS
Mailing Address - State:CT
Mailing Address - Zip Code:06076-3415
Mailing Address - Country:US
Mailing Address - Phone:413-297-6503
Mailing Address - Fax:
Practice Address - Street 1:39 COLBURN RD
Practice Address - Street 2:
Practice Address - City:STAFFORD SPRINGS
Practice Address - State:CT
Practice Address - Zip Code:06076-3415
Practice Address - Country:US
Practice Address - Phone:413-297-6503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9985183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT9985OtherPHARMACIST