Provider Demographics
NPI:1215767512
Name:UNDERWOOD, JESSE ALLAN (PHARMACIST)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:ALLAN
Last Name:UNDERWOOD
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 SWALLOW TAIL CIR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-9579
Mailing Address - Country:US
Mailing Address - Phone:912-314-9009
Mailing Address - Fax:
Practice Address - Street 1:60 SWALLOW TAIL CIR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-9579
Practice Address - Country:US
Practice Address - Phone:912-314-9009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0033145183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist