| NPI | 1083272199 |
|---|---|
| Former Name | JESSICA VITAL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P0200X Pharmacist, Pediatrics (Licence: CT PCT.0010770) |
| Additional Taxonomies | 1835P0200X Pharmacist, Pediatrics (Licence: MA PH27454) |
| 1835P0200X Pharmacist, Pediatrics (Licence: NY 053653) | |
| Enumeration Date | 2019-06-04 |
| Last Update Date | 2019-06-04 |