Provider Demographics
NPI:1184278517
Name:DUNBAR, JESSICA RENE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENE
Last Name:DUNBAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 ROBIN ST
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-1924
Mailing Address - Country:US
Mailing Address - Phone:716-785-1215
Mailing Address - Fax:
Practice Address - Street 1:2887 HARLEM RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-3038
Practice Address - Country:US
Practice Address - Phone:716-892-8115
Practice Address - Fax:716-892-6027
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23103183500000X
NY065415183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist