Basic Information
| Provider Information | |||||||||
| NPI: | 1700996733 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORREIA | ||||||||
| FirstName: | JAIME | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 94 BRIDLEPATH DR | ||||||||
| Address2: | |||||||||
| City: | SOUTHINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064894046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606989082 | ||||||||
| FaxNumber: | 8606676791 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 WILLARD AVE # 119 | ||||||||
| Address2: | |||||||||
| City: | NEWINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061112631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606666951 | ||||||||
| FaxNumber: | 8606676791 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 04/19/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P1200X | 25685 | MA | Y | Pharmacy Service Providers | Pharmacist | Pharmacotherapy |
No ID Information.