Provider Demographics
NPI:1558341404
Name:DREYER, JODY ALAN (PHARMD, BCPS)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:ALAN
Last Name:DREYER
Suffix:
Gender:M
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 819, BOX 18-205
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09645
Mailing Address - Country:US
Mailing Address - Phone:0113495-682-5609
Mailing Address - Fax:0113495-682-2780
Practice Address - Street 1:PSC 819, BOX 18
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09645
Practice Address - Country:ES
Practice Address - Phone:0113495-682-2120
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist