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General NPI Number Information
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NPI Number | 1154815942
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Entity Type | Individual
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Provider Name | JASON BARTLEY JEFFERY
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Gender | Male
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Dates
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Enumeration Date | 06/15/2018
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Last Update Date | 06/15/2018
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Provider Practice Location Address
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Address Line | 220 ALBANY TPKE
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City | CANTON
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State | CT
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Zip | 06019-7068
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Country | US
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Telephone | 860-693-8329
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Fax |
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Provider Business Mailing Address
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Address Line | 220 ALBANY TPKE
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City | CANTON
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State | CT
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Zip | 06019-7068
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Country | US
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Telephone | 860-693-8329
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PCT.0010174
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License Number State | CT
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