Provider Demographics
NPI:1356129423
Name:CUMBERLEDGE, JESSE ALEXANDER (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:ALEXANDER
Last Name:CUMBERLEDGE
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 STERLING RUN BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT ORAB
Mailing Address - State:OH
Mailing Address - Zip Code:45154-8395
Mailing Address - Country:US
Mailing Address - Phone:937-444-6911
Mailing Address - Fax:937-444-5013
Practice Address - Street 1:210 STERLING RUN BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT ORAB
Practice Address - State:OH
Practice Address - Zip Code:45154-8395
Practice Address - Country:US
Practice Address - Phone:937-444-6911
Practice Address - Fax:937-444-5013
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH034430541835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist