Provider Demographics
NPI:1255688024
Name:VACCARO, EDWARD JOSEPH (RPH)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:JOSEPH
Last Name:VACCARO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WAGON WHEEL DR
Mailing Address - Street 2:
Mailing Address - City:FRENCHTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08825-4231
Mailing Address - Country:US
Mailing Address - Phone:609-828-1441
Mailing Address - Fax:
Practice Address - Street 1:10 WAGON WHEEL DR
Practice Address - Street 2:
Practice Address - City:FRENCHTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08825-4231
Practice Address - Country:US
Practice Address - Phone:609-828-1441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28R101541500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0189201Medicaid