Provider Demographics
NPI:1992412167
Name:VENTIMIGLIA, CASEY MAUREEN
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:MAUREEN
Last Name:VENTIMIGLIA
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 1:73 LLOYD DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-1152
Mailing Address - Country:US
Mailing Address - Phone:203-615-3141
Mailing Address - Fax:
Practice Address - Street 1:1000 PARK AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-3406
Practice Address - Country:US
Practice Address - Phone:203-696-0127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0016116183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist