Provider Demographics
NPI:1386135465
Name:BERMAN, JAY ALAN (BS PHARM)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:ALAN
Last Name:BERMAN
Suffix:
Gender:M
Credentials:BS PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 JOHN OLDS DR APT 1
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-8789
Mailing Address - Country:US
Mailing Address - Phone:860-608-9674
Mailing Address - Fax:
Practice Address - Street 1:420 BUCKLAND HILLS DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-8755
Practice Address - Country:US
Practice Address - Phone:860-644-5105
Practice Address - Fax:860-644-4164
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0006941183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist