Provider Demographics
NPI:1053514505
Name:MEMOLI, PEGGY M (PHARMD,RPH)
Entity type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:M
Last Name:MEMOLI
Suffix:
Gender:F
Credentials:PHARMD,RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 N PETERS LN
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-8921
Mailing Address - Country:US
Mailing Address - Phone:203-378-2987
Mailing Address - Fax:203-378-2987
Practice Address - Street 1:1717 N PETERS LN
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-8921
Practice Address - Country:US
Practice Address - Phone:203-378-2987
Practice Address - Fax:203-378-2987
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT70081835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy