Provider Demographics
NPI:1699551150
Name:VACCARO, JORDAN
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:VACCARO
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 1:1860 HARTFORD TPKE
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-1248
Mailing Address - Country:US
Mailing Address - Phone:203-804-0851
Mailing Address - Fax:
Practice Address - Street 1:284 S COLONY RD
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-4554
Practice Address - Country:US
Practice Address - Phone:203-265-6336
Practice Address - Fax:203-265-2364
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0016305183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist