Provider Demographics
NPI:1306286414
Name:CAVALLARO, JESSICA L (PHARMD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
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 1:29 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029-3615
Mailing Address - Country:US
Mailing Address - Phone:203-671-1031
Mailing Address - Fax:860-454-8137
Practice Address - Street 1:29 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:ELLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06029-3615
Practice Address - Country:US
Practice Address - Phone:203-671-1031
Practice Address - Fax:860-454-8137
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist