Provider Demographics
NPI:1033305867
Name:KUNDRESKAS, JODY K (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:K
Last Name:KUNDRESKAS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:JODY
Other - Middle Name:K
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:72 TOWN FARM RD
Mailing Address - Street 2:
Mailing Address - City:VASSALBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04989-4034
Mailing Address - Country:US
Mailing Address - Phone:207-577-7272
Mailing Address - Fax:
Practice Address - Street 1:1 VA CTR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-6719
Practice Address - Country:US
Practice Address - Phone:207-623-8411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5419183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist