Active NPI
Soo Dewolf
- Pharmacist
- Brooklyn, CT
National Provider Identifier
1699143685
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 9104
- Practice address
- 450 Providence Rd
Brooklyn, CT 06234-1823 - Phone
- (860) 412-5144
- Fax
- (860) 412-5138
- NPI assigned
- Sep 8, 2015
- Last updated
- Sep 8, 2015
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 9104 | CT | Primary |
Addresses
Primary practice location
450 Providence Rd
Brooklyn, CT 06234-1823
Mailing address
450 Providence Rd
Brooklyn, CT 06234-1823
Phone (860) 412-5144
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 |
|---|---|---|---|
| 9104 | CT | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1441670400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1441670400000",
"number": "1699143685",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "450 PROVIDENCE RD",
"city": "BROOKLYN",
"state": "CT",
"postal_code": "062341823",
"telephone_number": "860-412-5144",
"fax_number": "860-412-5138"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "450 PROVIDENCE RD",
"city": "BROOKLYN",
"state": "CT",
"postal_code": "062341823",
"telephone_number": "860-412-5144",
"fax_number": "860-412-5138"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEWOLF",
"first_name": "SOO",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-09-08",
"last_updated": "2015-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CT",
"license": "9104",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.