Provider Demographics
NPI:1538217633
Name:FUNARO, EDMUND J SR (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:EDMUND
Middle Name:J
Last Name:FUNARO
Suffix:SR
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 TOWPATH LN
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-3314
Mailing Address - Country:US
Mailing Address - Phone:203-272-5943
Mailing Address - Fax:
Practice Address - Street 1:714 DIXWELL AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-1038
Practice Address - Country:US
Practice Address - Phone:203-562-6878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3928183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT04026233Medicaid