Provider Demographics
NPI:1053586024
Name:SHICK, JEFFERY A (RPH)
Entity type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:A
Last Name:SHICK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 MARYLAND AVE NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-4407
Mailing Address - Country:US
Mailing Address - Phone:202-396-1458
Mailing Address - Fax:301-634-5917
Practice Address - Street 1:4500 E WEST HWY STE 900
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3417
Practice Address - Country:US
Practice Address - Phone:301-657-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2019-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-22336183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist