Provider Demographics
NPI:1902125875
Name:UCONN HEALTH CENTER PHARMACY
Entity Type:Organization
Organization Name:UCONN HEALTH CENTER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR CMHC
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:TRESTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-679-5596
Mailing Address - Street 1:263 FARMINGTON AVE
Mailing Address - Street 2:MC 6202
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-6202
Mailing Address - Country:US
Mailing Address - Phone:860-679-7920
Mailing Address - Fax:860-679-8020
Practice Address - Street 1:270 FARMINGTON AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1909
Practice Address - Country:US
Practice Address - Phone:860-679-7915
Practice Address - Fax:860-679-8020
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF CONNECTICUT HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0065282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital