Provider Demographics
NPI:1538769997
Name:DUNBAR, JACKIE KENDELL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JACKIE
Middle Name:KENDELL
Last Name:DUNBAR
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 1:3250 SARDIS CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-6019
Mailing Address - Country:US
Mailing Address - Phone:678-546-6406
Mailing Address - Fax:
Practice Address - Street 1:3250 SARDIS CHURCH RD
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-6019
Practice Address - Country:US
Practice Address - Phone:678-546-6406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11370183500000X
GA025841183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0000001OtherNONE