Healthcare Provider Details

I. General information

NPI: 1518636877
Provider Name (Legal Business Name): JACOB AARON GREENWALD PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 03/22/2026
Certification Date: 03/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1078 SILAS DEANE HWY
WETHERSFIELD CT
06109-4231
US

IV. Provider business mailing address

285 ORCHARD AVE
NEWINGTON CT
06111-5439
US

V. Phone/Fax

Practice location:
  • Phone: 860-529-2535
  • Fax:
Mailing address:
  • Phone: 860-614-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH240327
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: