Ivan Thomas Jubilee II, PHARMD
Individual provider Active NPI Pharmacist · Stamford, CT
NPI 1215767009 · NPPES record last updated Aug 6, 2024
Key facts
- NPI
- 1215767009
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PCT.0016766 (CT)
- Practice address
- 537 Canal St
Stamford, CT 06902-5901 - Phone
- (203) 323-1293
- NPI assigned
- Aug 6, 2024
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PCT.0016766 | CT | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Connecticut CVS Pharmacy LLC | Past |
Accepting new patients | |
| Connecticut CVS Pharmacy LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PCT.0016766 | CT | Yes |
Addresses
Primary practice location
537 Canal St
Stamford, CT 06902-5901
Mailing address
121 Towne St Apt 204
Stamford, CT 06902-5936
Phone (607) 207-8587
Other providers in Stamford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 6, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.