Provider Demographics
NPI:1386407500
Name:CINA, JEZERCA
Entity type:Individual
Prefix:
First Name:JEZERCA
Middle Name:
Last Name:CINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 ELLIOTT RD
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-2246
Mailing Address - Country:US
Mailing Address - Phone:914-536-1442
Mailing Address - Fax:
Practice Address - Street 1:600 DERBY AVE
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-1000
Practice Address - Country:US
Practice Address - Phone:833-487-9644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.00161201835C0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835C0207XPharmacy Service ProvidersPharmacistCompounded Sterile Preparations