Provider Demographics
NPI:1205467024
Name:BADICHEK, JESSICA MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:BADICHEK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 COURT ST STE 603
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3367
Mailing Address - Country:US
Mailing Address - Phone:877-742-6992
Mailing Address - Fax:
Practice Address - Street 1:213 COURT ST STE 603
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3367
Practice Address - Country:US
Practice Address - Phone:860-593-0522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0014053183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist