Provider Demographics
NPI:1255942009
Name:SPANGLER, JESSICA CARLA (PHARMD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:CARLA
Last Name:SPANGLER
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 1:1 JULIAN TER
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2705
Mailing Address - Country:US
Mailing Address - Phone:856-430-8494
Mailing Address - Fax:
Practice Address - Street 1:399 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-5414
Practice Address - Country:US
Practice Address - Phone:860-885-0389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0015203183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTPCT.0015203OtherPHARMACIST LICENSE