Healthcare Provider Details

I. General information

NPI: 1699551150
Provider Name (Legal Business Name): JORDAN VACCARO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 S COLONY RD
WALLINGFORD CT
06492-4554
US

IV. Provider business mailing address

1860 HARTFORD TPKE
NORTH HAVEN CT
06473-1248
US

V. Phone/Fax

Practice location:
  • Phone: 203-265-6336
  • Fax: 203-265-2364
Mailing address:
  • Phone: 203-804-0851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0016305
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: