Provider Demographics
NPI:1851112601
Name:STEWART, JEAN
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 PROGRESS LANE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-3863
Mailing Address - Country:US
Mailing Address - Phone:203-753-7778
Mailing Address - Fax:203-753-7779
Practice Address - Street 1:84 PROGRESS LANE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-3863
Practice Address - Country:US
Practice Address - Phone:203-753-7778
Practice Address - Fax:203-753-7779
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7994183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist