MEDICARE: MR. JAMES JOSEPH CAVAGE II PHARM D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	RP438506	PA

General Provider Information

NPI Number	:	1700483120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES JOSEPH CAVAGE II PHARM D.

Provider Business Mailing Address
First Line	:	98 GREENCASTLE LN
Second Line	:
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-1765
Country	:	US
Telephone Number	:	570-262-3934
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 STEVENS DR
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19113-1532
Country	:	US
Telephone Number	:	215-863-6372
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2020
Last Update Date	:	05/19/2022

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