Provider Demographics
NPI:1780975508
Name:DESMARAIS, ANNA (RPH)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:
Last Name:DESMARAIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 KENEDY DR
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260
Mailing Address - Country:US
Mailing Address - Phone:860-928-3813
Mailing Address - Fax:860-928-6298
Practice Address - Street 1:203 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1628
Practice Address - Country:US
Practice Address - Phone:860-928-3813
Practice Address - Fax:860-928-6298
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10333183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist