Provider Demographics
NPI:1821969221
Name:WROBLEWSKI, MAYA WANLA
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:WANLA
Last Name:WROBLEWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 WORTHINGTON RDG
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-2332
Mailing Address - Country:US
Mailing Address - Phone:860-538-1633
Mailing Address - Fax:
Practice Address - Street 1:150 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-4405
Practice Address - Country:US
Practice Address - Phone:860-595-1750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0017140183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist