Provider Demographics
NPI:1386344950
Name:ABRAHAM, MARY RAHUL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:RAHUL
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:POONNOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:79 WHITEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2133
Mailing Address - Country:US
Mailing Address - Phone:860-817-0375
Mailing Address - Fax:
Practice Address - Street 1:950 CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-2770
Practice Address - Country:US
Practice Address - Phone:203-932-5711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0013306183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist