Provider Demographics
NPI:1245608363
Name:LEZAMA, JEFFREY (RPH)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:LEZAMA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8490 ICE CRYSTAL DR
Mailing Address - Street 2:UNIT #N
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-2065
Mailing Address - Country:US
Mailing Address - Phone:240-472-2557
Mailing Address - Fax:301-962-7248
Practice Address - Street 1:12209 VEIRS MILL RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-4506
Practice Address - Country:US
Practice Address - Phone:240-472-2557
Practice Address - Fax:301-962-7248
Is Sole Proprietor?:No
Enumeration Date:2015-09-05
Last Update Date:2015-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13677183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist