Provider Demographics
NPI:1205591039
Name:MCGURK, JAIME ANNE
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:ANNE
Last Name:MCGURK
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 1:65 ABNER ST
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-3306
Mailing Address - Country:US
Mailing Address - Phone:585-709-0331
Mailing Address - Fax:
Practice Address - Street 1:325 FERRY ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513-3764
Practice Address - Country:US
Practice Address - Phone:203-777-0695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-06
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPTN.0025687183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician