Healthcare Provider Details

I. General information

NPI: 1700996733
Provider Name (Legal Business Name): JAIME L CORREIA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 WILLARD AVE # 119
NEWINGTON CT
06111-2631
US

IV. Provider business mailing address

94 BRIDLE PATH DR
SOUTHINGTON CT
06489-4046
US

V. Phone/Fax

Practice location:
  • Phone: 860-666-6951
  • Fax: 860-667-6791
Mailing address:
  • Phone: 617-512-0327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number25685
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: