Provider Demographics
NPI:1942194154
Name:MIEREK, ALEXIS NOELLE
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:NOELLE
Last Name:MIEREK
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 1:28 PEACH ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712-1050
Mailing Address - Country:US
Mailing Address - Phone:315-725-0045
Mailing Address - Fax:
Practice Address - Street 1:775 MAIN ST S
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2271
Practice Address - Country:US
Practice Address - Phone:203-262-1477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0016730183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist