Provider Demographics
NPI:1972898864
Name:CUDMORE, JESSICA LYNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LYNE
Last Name:CUDMORE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 BIRDCAGE ST
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-6800
Mailing Address - Country:US
Mailing Address - Phone:916-500-1263
Mailing Address - Fax:
Practice Address - Street 1:5800 BIRDCAGE ST
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-6800
Practice Address - Country:US
Practice Address - Phone:916-500-1263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-18
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65035183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist