Provider Demographics
NPI:1548477888
Name:DISNEY, JEFFREY LEE (RPH)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:LEE
Last Name:DISNEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 CLOVER DR
Mailing Address - Street 2:
Mailing Address - City:LITTLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17340-9599
Mailing Address - Country:US
Mailing Address - Phone:717-359-9488
Mailing Address - Fax:
Practice Address - Street 1:205 WASHINGTON HEIGHTS MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157
Practice Address - Country:US
Practice Address - Phone:410-848-8900
Practice Address - Fax:410-848-5233
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09586183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist