Provider Demographics
NPI:1366077752
Name:DELLARAGIONE, JESSICA (RPH)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:DELLARAGIONE
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 1:31 PEGASUS DR
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-2874
Mailing Address - Country:US
Mailing Address - Phone:917-837-7466
Mailing Address - Fax:
Practice Address - Street 1:695 CENTRAL AVE STE 203
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3662
Practice Address - Country:US
Practice Address - Phone:866-234-4974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02642500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist