Provider Demographics
NPI:1427652411
Name:ISMAILI, AGRON
Entity type:Individual
Prefix:
First Name:AGRON
Middle Name:
Last Name:ISMAILI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 MACBEAN DR
Mailing Address - Street 2:
Mailing Address - City:NEW FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06812-2661
Mailing Address - Country:US
Mailing Address - Phone:203-297-5246
Mailing Address - Fax:
Practice Address - Street 1:526 MERIDEN RD
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-2217
Practice Address - Country:US
Practice Address - Phone:203-465-7055
Practice Address - Fax:203-597-9296
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0010315183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist