Provider Demographics
NPI:1114531605
Name:SILVA, JESSICA LEIGH (PHARMD, RPH, CDOE)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEIGH
Last Name:SILVA
Suffix:
Gender:F
Credentials:PHARMD, RPH, CDOE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 HYACINTH ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-7600
Mailing Address - Country:US
Mailing Address - Phone:774-488-9964
Mailing Address - Fax:
Practice Address - Street 1:1150 NEW LONDON AVE STE 210
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-3036
Practice Address - Country:US
Practice Address - Phone:401-935-0336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH240204183500000X
RIRPH06127183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist