Healthcare Provider Details

I. General information

NPI: 1427870823
Provider Name (Legal Business Name): CELINA VACCARO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8333 ROCKSIDE RD
CLEVELAND OH
44125-6134
US

IV. Provider business mailing address

56 MONTICELLO DR
SICKLERVILLE NJ
08081-2310
US

V. Phone/Fax

Practice location:
  • Phone: 877-355-7225
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04402200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: