Provider Demographics
NPI:1154643666
Name:BURRIDGE, JARED MICHAEL (PHARM D)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:MICHAEL
Last Name:BURRIDGE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 ROUTE 146
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3679
Mailing Address - Country:US
Mailing Address - Phone:518-371-6155
Mailing Address - Fax:
Practice Address - Street 1:1028 ROUTE 146
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3679
Practice Address - Country:US
Practice Address - Phone:518-371-6155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053454183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist