Provider Demographics
NPI:1083904130
Name:THORNSBURY, JESSICA ANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ANN
Last Name:THORNSBURY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 PITTS FRK
Mailing Address - Street 2:
Mailing Address - City:DAVID
Mailing Address - State:KY
Mailing Address - Zip Code:41616-9043
Mailing Address - Country:US
Mailing Address - Phone:606-886-8941
Mailing Address - Fax:
Practice Address - Street 1:262 KY RT 122
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:KY
Practice Address - Zip Code:41649
Practice Address - Country:US
Practice Address - Phone:606-285-9908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY014176183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist