Provider Demographics
NPI:1366725442
Name:PUGLIESE, RYAN A (PHARMD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:A
Last Name:PUGLIESE
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 1:160 CANTON RD
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06035-2704
Mailing Address - Country:US
Mailing Address - Phone:860-817-1487
Mailing Address - Fax:
Practice Address - Street 1:28 E ELM ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-5016
Practice Address - Country:US
Practice Address - Phone:860-482-5621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-24
Last Update Date:2011-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0010513183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTPCT.0010513OtherSTATE LICENSE