Provider Demographics
NPI:1194027979
Name:FARMER, JESSICA NICOLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
Last Name:FARMER
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 1:3431 KILBURN CIR
Mailing Address - Street 2:APT 523
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1098
Mailing Address - Country:US
Mailing Address - Phone:804-338-2718
Mailing Address - Fax:
Practice Address - Street 1:2801 HICKS RD
Practice Address - Street 2:KROGER PHARMACY
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-6337
Practice Address - Country:US
Practice Address - Phone:804-675-4519
Practice Address - Fax:804-675-4528
Is Sole Proprietor?:No
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202208063183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist