Provider Demographics
NPI:1245690247
Name:PANTALENA, RAY (RPH)
Entity type:Individual
Prefix:
First Name:RAY
Middle Name:
Last Name:PANTALENA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 BARTLETT DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-8200
Mailing Address - Country:US
Mailing Address - Phone:203-530-8885
Mailing Address - Fax:203-876-8439
Practice Address - Street 1:78 BROAD ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3353
Practice Address - Country:US
Practice Address - Phone:203-878-2441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT 5701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist