Provider Demographics
NPI:1427277615
Name:CAVALLARO, EDWARD B
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:B
Last Name:CAVALLARO
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:EDWARD
Other - Middle Name:BENJAMIN
Other - Last Name:CAVALLARO
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
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
PARP040152L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist