Provider Demographics
NPI:1518370584
Name:INGALLS, JEFFREY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:INGALLS
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 1:11190 VEIRS MILL RD
Mailing Address - Street 2:CVS/PHARMACY
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-2553
Mailing Address - Country:US
Mailing Address - Phone:301-942-1791
Mailing Address - Fax:301-942-0145
Practice Address - Street 1:11190 VEIRS MILL RD
Practice Address - Street 2:CVS/PHARMACY
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-2553
Practice Address - Country:US
Practice Address - Phone:301-942-1791
Practice Address - Fax:301-942-0145
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-08
Last Update Date:2014-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20806183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD20806OtherMARYLAND PHARMACIST LICENSE
MDV20806OtherMARYLAND IMMUNIZING PHARMACIST LICENSE