Active NPI
Catherine Ann Koivisto, RPH
- Pharmacist
- Mashantucket, CT
National Provider Identifier
1639480163
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- CT9619
- Practice address
- 1 Annie George Dr
Mashantucket, CT 06338-3801 - Phone
- (888) 779-6362
- Fax
- (800) 779-6329
- NPI assigned
- Jun 30, 2010
- Last updated
- Jun 30, 2010
- Sex
- Female
- Sole proprietor
- Yes
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 | RI3994 | RI | |
| Pharmacist | 183500000X | CT9619 | CT | Primary |
| Pharmacist | 183500000X | 27765 | MA |
Addresses
Primary practice location
1 Annie George Dr
Mashantucket, CT 06338-3801
Mailing address
9 Fox Hill Rd
Pomfret Center, CT 06259-1134
Phone (860) 928-6034
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 |
|---|---|---|---|
| CT9619 | CT | MD | Pharmacist |
| RI3994 | RI | MD | Pharmacist |
| 27765 | MA | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1277856000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1277856000000",
"number": "1639480163",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9 FOX HILL RD",
"city": "POMFRET CENTER",
"state": "CT",
"postal_code": "062591134",
"telephone_number": "860-928-6034",
"fax_number": "860-963-7951"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 ANNIE GEORGE DR",
"city": "MASHANTUCKET",
"state": "CT",
"postal_code": "063383801",
"telephone_number": "888-779-6362",
"fax_number": "800-779-6329"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOIVISTO",
"first_name": "CATHERINE",
"middle_name": "ANN",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-06-30",
"last_updated": "2010-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "RI",
"license": "RI3994",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CT",
"license": "CT9619",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MA",
"license": "27765",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mashantucket, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.