Healthcare Provider Details

I. General information

NPI: 1073236337
Provider Name (Legal Business Name): JESSICA VACCARO PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15990 N GREENWAY HAYDEN LOOP STE D100
SCOTTSDALE AZ
85260-2269
US

IV. Provider business mailing address

6321 E GREENWAY RD
SCOTTSDALE AZ
85254-1910
US

V. Phone/Fax

Practice location:
  • Phone: 877-662-6633
  • Fax:
Mailing address:
  • Phone: 702-467-9139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS026108
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: