Provider Demographics
NPI:1487375903
Name:COLLETTE, RYANN KATHLEEN
Entity type:Individual
Prefix:
First Name:RYANN
Middle Name:KATHLEEN
Last Name:COLLETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 NORTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-1701
Mailing Address - Country:US
Mailing Address - Phone:203-725-4217
Mailing Address - Fax:
Practice Address - Street 1:410 REIDVILLE DR STE 1
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-2683
Practice Address - Country:US
Practice Address - Phone:203-755-5814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0016045183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist