Provider Demographics
NPI:1023230943
Name:DEMAREST, DUDLEY ALVIN JR (BPHARM, MBA, PHD)
Entity type:Individual
Prefix:MR
First Name:DUDLEY
Middle Name:ALVIN
Last Name:DEMAREST
Suffix:JR
Gender:M
Credentials:BPHARM, MBA, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4624 EDMONDSON AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-1407
Mailing Address - Country:US
Mailing Address - Phone:410-362-1375
Mailing Address - Fax:410-534-5190
Practice Address - Street 1:4624 EDMONDSON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-1407
Practice Address - Country:US
Practice Address - Phone:410-362-1375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD09795183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist