Provider Demographics
NPI:1083272199
Name:VITAL-CARONA, JESSICA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:VITAL-CARONA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:VITAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:296 PINE CONE LN
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-1379
Mailing Address - Country:US
Mailing Address - Phone:413-297-4019
Mailing Address - Fax:203-688-4131
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-688-1838
Practice Address - Fax:203-688-4131
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH274541835P0200X
NY0536531835P0200X
CTPCT.00107701835P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0200XPharmacy Service ProvidersPharmacistPediatrics