Provider Demographics
NPI:1871629337
Name:COMDEN, JON GARY II (RPH)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:GARY
Last Name:COMDEN
Suffix:II
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:225 BRAXCARR ST
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-7645
Mailing Address - Country:US
Mailing Address - Phone:919-552-7971
Mailing Address - Fax:919-363-9849
Practice Address - Street 1:5277 SUNSET LAKE RD
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-3768
Practice Address - Country:US
Practice Address - Phone:919-363-4729
Practice Address - Fax:919-363-9849
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302023100183500000X
NC19274183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302023100OtherPHARMACIST LICENSE NUMBER
NC19274OtherNORTH CAROLINA PHARMACY LICENSE