Provider Demographics
NPI:1033629589
Name:CRANE, JESSICA (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:CRANE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:911 E ROLLINS ST.
Mailing Address - Street 2:ROOM 1207 MIZZOU PHARMACY
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65211
Mailing Address - Country:US
Mailing Address - Phone:573-884-4373
Mailing Address - Fax:573-882-4843
Practice Address - Street 1:911 E ROLLINS ST.
Practice Address - Street 2:ROOM 1207 MIZZOU PHARMACY
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65211
Practice Address - Country:US
Practice Address - Phone:573-884-4373
Practice Address - Fax:573-552-4843
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016035857183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist