Provider Demographics
NPI:1043850704
Name:KUCHARCZYK, ANNA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:KUCHARCZYK
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 1:7 BENANTO DR
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-2247
Mailing Address - Country:US
Mailing Address - Phone:203-751-7567
Mailing Address - Fax:
Practice Address - Street 1:24 PERSHING DR
Practice Address - Street 2:
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-2214
Practice Address - Country:US
Practice Address - Phone:203-735-7837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0014572183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist