Jacob Badura
Individual provider Active NPI Pharmacist · Bloomfield, CT
NPI 1669835138 · NPPES record last updated Apr 1, 2016
Key facts
- NPI
- 1669835138
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PCT.0011967 (CT)
- Practice address
- 799-824 Park Ave
Bloomfield, CT 06002 - Phone
- (860) 243-1704
- NPI assigned
- Apr 1, 2016
- 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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PCT.0011967 | CT | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PCT.0011967 | CT | Yes |
Addresses
Primary practice location
799-824 Park Ave
Bloomfield, CT 06002
Mailing address
45 Woodside Dr
South Windsor, CT 06074-3438
Phone (860) 874-6368
Other providers in Bloomfield, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 1, 2016. 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.