Provider Demographics
NPI:1457982266
Name:SONDERGAARD, JEFFREY ARTHUR (PHARMD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ARTHUR
Last Name:SONDERGAARD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 E WALTON BLVD
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48340-1277
Mailing Address - Country:US
Mailing Address - Phone:248-334-1896
Mailing Address - Fax:
Practice Address - Street 1:66 E WALTON BLVD
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48340-1277
Practice Address - Country:US
Practice Address - Phone:248-334-1896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302411674183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist