Provider Demographics
NPI:1457720633
Name:CUNANAN, JESSICA T (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:T
Last Name:CUNANAN
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 1:4603 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-1524
Mailing Address - Country:US
Mailing Address - Phone:301-595-2731
Mailing Address - Fax:
Practice Address - Street 1:3327 CONNECTICUT AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-1302
Practice Address - Country:US
Practice Address - Phone:202-966-7210
Practice Address - Fax:202-364-6142
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-17
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23420183500000X
DCPH100002173183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist