Healthcare Provider Details

I. General information

NPI: 1538161955
Provider Name (Legal Business Name): JACINTHA STALL CAUFFIELD PHARMD, BCPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. JACINTHA MARIE STALL

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 09/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 NE MOTHER JOSEPH PL
VANCOUVER WA
98664-3200
US

IV. Provider business mailing address

400 NE MOTHER JOSEPH PLACE
VANCOUVER WA
98664
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-2060
  • Fax:
Mailing address:
  • Phone: 360-514-2060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS30611
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00057767
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number298117
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: