Provider Demographics
NPI:1316210164
Name:DANDURAND, JEFFREY (PHARMD, BCPS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:DANDURAND
Suffix:
Gender:M
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 KNIGHT RD
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-4770
Mailing Address - Country:US
Mailing Address - Phone:860-803-0022
Mailing Address - Fax:
Practice Address - Street 1:316 TALBOTT AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4334
Practice Address - Country:US
Practice Address - Phone:413-543-1318
Practice Address - Fax:413-543-1319
Is Sole Proprietor?:No
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH27428183500000X
MA31002131835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy