Provider Demographics
NPI:1437458544
Name:RUP, JEFFREY ANDREW (RPH)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ANDREW
Last Name:RUP
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 1:251 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-9194
Mailing Address - Country:US
Mailing Address - Phone:919-557-5322
Mailing Address - Fax:919-557-5897
Practice Address - Street 1:251 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-9194
Practice Address - Country:US
Practice Address - Phone:919-557-5322
Practice Address - Fax:919-557-5897
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14782183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist