Provider Demographics
NPI:1730779935
Name:TANGUAY, ROBERT (CPHT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:TANGUAY
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06704-3508
Mailing Address - Country:US
Mailing Address - Phone:203-753-5158
Mailing Address - Fax:203-597-0625
Practice Address - Street 1:675 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06704-3508
Practice Address - Country:US
Practice Address - Phone:203-753-5158
Practice Address - Fax:203-597-0625
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPTN.0001065183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician