Provider Demographics
NPI:1053990721
Name:ARREDONDO, JEFFREY RUSSELL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:RUSSELL
Last Name:ARREDONDO
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 1:196 BEAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:NORTH WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1004
Mailing Address - Country:US
Mailing Address - Phone:781-966-2700
Mailing Address - Fax:
Practice Address - Street 1:196 BEAR HILL RD
Practice Address - Street 2:
Practice Address - City:NORTH WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1004
Practice Address - Country:US
Practice Address - Phone:781-966-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH233797183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist