Healthcare Provider Details

I. General information

NPI: 1073315115
Provider Name (Legal Business Name): CASSIDY EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 CAMPBELL AVE
WEST HAVEN CT
06516-2770
US

IV. Provider business mailing address

2408 BRAKEN AVE
WILMINGTON DE
19808-4432
US

V. Phone/Fax

Practice location:
  • Phone: 302-379-4463
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number033.0135828
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: