Active NPI
Maryjane Couillard, RPH
- Pharmacist
- Waterford, CT
National Provider Identifier
1003395542
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PCT.0014296
- Practice address
- 155 Waterford Pkwy N
Waterford, CT 06385-1208 - Phone
- (860) 447-3747
- NPI assigned
- Aug 7, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PR4073 | ME | |
| Pharmacist | 183500000X | PCT.0014296 | CT | Primary |
Addresses
Primary practice location
155 Waterford Pkwy N
Waterford, CT 06385-1208
Mailing address
155 Waterford Pkwy N
Waterford, CT 06385-1208
Phone (860) 447-3747
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PCT.0014296 | CT | MD | Pharmacist |
| PR4073 | ME | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1533600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686009600000",
"number": "1003395542",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "155 WATERFORD PKWY N",
"city": "WATERFORD",
"state": "CT",
"postal_code": "063851208",
"telephone_number": "860-447-3747"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "155 WATERFORD PKWY N",
"city": "WATERFORD",
"state": "CT",
"postal_code": "063851208",
"telephone_number": "860-447-3747"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COUILLARD",
"first_name": "MARYJANE",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-08-07",
"last_updated": "2023-06-06",
"certification_date": "2023-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ME",
"license": "PR4073",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CT",
"license": "PCT.0014296",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.