Provider Demographics
NPI:1720681505
Name:DEFENDERFER, MARY JESSAMYN (PHARMD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JESSAMYN
Last Name:DEFENDERFER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:JESSAMYN
Other - Last Name:BARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1525 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1539
Mailing Address - Country:US
Mailing Address - Phone:334-263-9272
Mailing Address - Fax:
Practice Address - Street 1:1525 FOREST AVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1539
Practice Address - Country:US
Practice Address - Phone:334-263-9272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41152183500000X
AL19875183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist