Peter Tyczkowski, R.PH.
Individual provider Active NPI Pharmacist · Storrs Mansfield, CT
NPI 1174685663 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1174685663
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 5409 (CT)
- Practice address
- 69 N Eagleville Rd Unit 3092
Storrs Mansfield, CT 06269-3092 - Phone
- (860) 486-3151
- NPI assigned
- Dec 14, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5409 | CT | MD | Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5409 | CT | Yes |
Addresses
Primary practice location
69 N Eagleville Rd Unit 3092
Storrs Mansfield, CT 06269-3092
Mailing address
523 E Carriage Dr
Glastonbury, CT 06033-3302
Phone (860) 486-3151
Other providers in Storrs Mansfield, CT
- David Tiberio
- William Toomey
- Town of Mansfield
- Town of Mansfield Department of Education
- Ellen Donohue Tulman
- University of Connecticut
- University of Connecticut
- University of Connecticut Student Health and Wellness
- Margaret Van Kuren
- Douglas M Whittemore
All providers in Storrs Mansfield, CT · Pharmacist in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.