Provider Demographics
NPI:1447993316
Name:MONTGOMERY, IMAN NIA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:IMAN
Middle Name:NIA
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 173
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06141-0173
Mailing Address - Country:US
Mailing Address - Phone:661-378-3883
Mailing Address - Fax:
Practice Address - Street 1:484 WINDSOR AVE
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-4401
Practice Address - Country:US
Practice Address - Phone:860-947-5078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0015744183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist