Provider Demographics
NPI:1316717895
Name:MASTROIANNI, ADAM MICHAEL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:MICHAEL
Last Name:MASTROIANNI
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 1:377 CHESTNUT TREE HILL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-1989
Mailing Address - Country:US
Mailing Address - Phone:203-819-1213
Mailing Address - Fax:
Practice Address - Street 1:377 CHESTNUT TREE HILL RD
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-1989
Practice Address - Country:US
Practice Address - Phone:203-819-1213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0016359183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist