Provider Demographics
NPI:1194902965
Name:CAVOLINA, JASON MAX (PHARMD, RPH, MS)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:MAX
Last Name:CAVOLINA
Suffix:
Gender:M
Credentials:PHARMD, RPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1304 ORCHID CIR
Mailing Address - Street 2:
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713-3013
Mailing Address - Country:US
Mailing Address - Phone:631-803-2572
Mailing Address - Fax:631-324-8587
Practice Address - Street 1:38 PANTIGO RD
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11937-2604
Practice Address - Country:US
Practice Address - Phone:631-324-8587
Practice Address - Fax:631-324-2720
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051127183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist