Provider Demographics
NPI:1306065503
Name:CAVALLARO, JACLYN V (PHARMD)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:V
Last Name:CAVALLARO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-3145
Mailing Address - Country:US
Mailing Address - Phone:856-228-5538
Mailing Address - Fax:
Practice Address - Street 1:1601 CHERRY ST
Practice Address - Street 2:SUITE 1700
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1321
Practice Address - Country:US
Practice Address - Phone:215-282-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP439069183500000X
NJ28RI02844500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist