Provider Demographics
NPI:1659079234
Name:BRUNDIDGE, JAMAAR (PHARMD)
Entity Type:Individual
Prefix:
First Name:JAMAAR
Middle Name:
Last Name:BRUNDIDGE
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 1:134 TURMAN AVE SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-5118
Mailing Address - Country:US
Mailing Address - Phone:678-595-2179
Mailing Address - Fax:
Practice Address - Street 1:134 TURMAN AVE SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-5118
Practice Address - Country:US
Practice Address - Phone:678-595-2179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH031044183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist