Provider Demographics
NPI:1861717183
Name:DUFRESNE, PAUL ERNEST (MS, RPH, DPH)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ERNEST
Last Name:DUFRESNE
Suffix:
Gender:M
Credentials:MS, RPH, DPH
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:ERNEST
Other - Last Name:DUFRESNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:31 MOODY RD
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-3101
Mailing Address - Country:US
Mailing Address - Phone:860-763-7020
Mailing Address - Fax:860-763-7022
Practice Address - Street 1:31 MOODY RD
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3101
Practice Address - Country:US
Practice Address - Phone:860-763-7020
Practice Address - Fax:860-763-7022
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT72001835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist