Provider Demographics
NPI:1083177208
Name:CHENEY, JESSICA M (PHARM D)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:CHENEY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 W BURLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-2645
Mailing Address - Country:US
Mailing Address - Phone:641-472-6199
Mailing Address - Fax:641-472-6147
Practice Address - Street 1:2701 W BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-2645
Practice Address - Country:US
Practice Address - Phone:641-472-6199
Practice Address - Fax:641-472-6147
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-14
Last Update Date:2019-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19949183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist