Basic Information
| Provider Information | |||||||||
| NPI: | 1063495216 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALBUJA | ||||||||
| FirstName: | EDGAR | ||||||||
| MiddleName: | DANIEL | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 321 MANSFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | WILLIMANTIC | ||||||||
| State: | CT | ||||||||
| PostalCode: | 062261217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604235508 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1315 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WILLIMANTIC | ||||||||
| State: | CT | ||||||||
| PostalCode: | 062261948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604507456 | ||||||||
| FaxNumber: | 8604507475 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 6979 | CT | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.