Active NPI
Ricky Phongsa
- Pharmacist
- Uncasville, CT
National Provider Identifier
1346765781
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PCT.0014070
- Practice address
- 601 Route 32
Uncasville, CT 06382-2104 - Phone
- (860) 848-7979
- NPI assigned
- Aug 7, 2017
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PCT.0014070 | CT | Primary |
Addresses
Primary practice location
601 Route 32
Uncasville, CT 06382-2104
Mailing address
119 S Main St
Colchester, CT 06415-1456
Phone (860) 537-0711
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PCT.0014070 | CT | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1502064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636848000000",
"number": "1346765781",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "119 S MAIN ST",
"city": "COLCHESTER",
"state": "CT",
"postal_code": "064151456",
"telephone_number": "860-537-0711"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "601 ROUTE 32",
"city": "UNCASVILLE",
"state": "CT",
"postal_code": "063822104",
"telephone_number": "860-848-7979"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHONGSA",
"first_name": "RICKY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-08-07",
"last_updated": "2021-11-14",
"certification_date": "2021-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CT",
"license": "PCT.0014070",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Uncasville, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.