Active NPI
Mark Peter Petruzzi, R.PH.
- Pharmacist
- South Windsor, CT
National Provider Identifier
1043213770
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PCT4633
- Practice address
- 78 Elizabeth St
South Windsor, CT 06074-3411 - Phone
- (860) 528-5019
- NPI assigned
- May 26, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 4633 | CT | |
| Pharmacist | 183500000X | PCT4633 | CT | Primary |
| Pharmacist | 183500000X | PH24321 | MA |
Addresses
Primary practice location
78 Elizabeth St
South Windsor, CT 06074-3411
Mailing address
56 Shipman Dr
Glastonburg, CT 06033
Phone (860) 633-1343
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 |
|---|---|---|---|
| 4633 | CT | MD | Pharmacist |
| PCT4633 | CT | MD | Pharmacist |
| PH24321 | MA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1117065600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320364800000",
"number": "1043213770",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "56 SHIPMAN DR",
"city": "GLASTONBURG",
"state": "CT",
"postal_code": "06033",
"telephone_number": "860-633-1343"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "78 ELIZABETH ST",
"city": "SOUTH WINDSOR",
"state": "CT",
"postal_code": "060743411",
"telephone_number": "860-528-5019"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRUZZI",
"first_name": "MARK",
"middle_name": "PETER",
"name_prefix": "Mr.",
"credential": "R.PH.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-05-26",
"last_updated": "2011-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CT",
"license": "4633",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CT",
"license": "PCT4633",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MA",
"license": "PH24321",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Windsor, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.