Provider Demographics
NPI:1407679046
Name:CARUCCI, KELLY MARIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:MARIE
Last Name:CARUCCI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 CHERRY BROOK LN
Mailing Address - Street 2:
Mailing Address - City:SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06078-1039
Mailing Address - Country:US
Mailing Address - Phone:860-335-8678
Mailing Address - Fax:
Practice Address - Street 1:142 TALCOTTVILLE RD
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4705
Practice Address - Country:US
Practice Address - Phone:860-871-1661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0016706183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist