Most Relevant Information
Provider Data
| NPI Number: | 1003270125 |
| Provider Name: | DERECK REALEJO |
| Entity Type: | Individual |
| Taxonomy Code: | 183500000X |
| Specialty: | Pharmacist |
| License Number: | 13436 |
Most Important Dates
| Enumeration Date: | 04/06/2016 |
| Last Updated: | 04/06/2016 |
Provider Practice Location
817 BANK ST
NEW LONDON
CT
06320
Practice Location Phone/Fax
| Phone: | 8604435359 |
| Fax: | 8604403336 |
Provider Mailing Location
817 BANK ST
NEW LONDON
CT
06320
Provider Mailing Phone/Fax
| Phone: | 8604435359 |
| Fax: | 8604403336 |