Provider Demographics
NPI:1023393618
Name:RISSE, JEFFREY (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:RISSE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 N POINTE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3405
Mailing Address - Country:US
Mailing Address - Phone:919-220-2742
Mailing Address - Fax:919-220-2749
Practice Address - Street 1:1510 N. POINTE DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3405
Practice Address - Country:US
Practice Address - Phone:919-220-2742
Practice Address - Fax:919-220-2749
Is Sole Proprietor?:No
Enumeration Date:2011-10-15
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC06929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist