Basic Information
| Provider Information | |||||||||
| NPI: | 1003561457 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KNOWLTON | ||||||||
| FirstName: | JILLANN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 HILLCREST DR | ||||||||
| Address2: | |||||||||
| City: | EAST GRANBY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609305593 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 577 MAIN ST STE 360 | ||||||||
| Address2: | |||||||||
| City: | HUDSON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017493046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9782123030 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2022 | ||||||||
| LastUpdateDate: | 02/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 6861 | CT | N | Pharmacy Service Providers | Pharmacist | 183500000X | 20072 | MA | Y | Pharmacy Service Providers | Pharmacist |
ID Information
| ID | Type | State | Issuer | Description | 273620 | 01 | NABP | OTHER |