Provider Demographics
NPI:1962796318
Name:NEDDEAU, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:NEDDEAU
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 1:900 HARTFORD TPKE
Mailing Address - Street 2:T-1267
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-4246
Mailing Address - Country:US
Mailing Address - Phone:860-443-3171
Mailing Address - Fax:860-443-3171
Practice Address - Street 1:900 HARTFORD TPKE
Practice Address - Street 2:T-1267
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-4246
Practice Address - Country:US
Practice Address - Phone:860-443-3171
Practice Address - Fax:860-443-3171
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7899183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist