Provider Demographics
NPI:1598369019
Name:DEPAOLA, JILLIAN L (RPH)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:L
Last Name:DEPAOLA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 WILLIAM S CANNING BLVD
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-2339
Mailing Address - Country:US
Mailing Address - Phone:508-678-9031
Mailing Address - Fax:508-675-1292
Practice Address - Street 1:245 WILLIAM S CANNING BLVD
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-2339
Practice Address - Country:US
Practice Address - Phone:508-678-9031
Practice Address - Fax:508-675-1292
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24827183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist