Provider Demographics
NPI:1780198440
Name:CUNDIFF, JEREMY (PHARM D RPH)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:
Last Name:CUNDIFF
Suffix:
Gender:M
Credentials:PHARM D RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4611 ASSEMBLY DRIVE UNIT H
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706
Mailing Address - Country:US
Mailing Address - Phone:240-624-2200
Mailing Address - Fax:410-789-8456
Practice Address - Street 1:4611 ASSEMBLY DRIVE
Practice Address - Street 2:UNIT H
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706
Practice Address - Country:US
Practice Address - Phone:240-624-2200
Practice Address - Fax:410-789-8456
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15494183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist