Provider Demographics
NPI:1225315914
Name:CHILDRESS, JESSICA RUTH (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:RUTH
Last Name:CHILDRESS
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 1:501 CAPERTON DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-6508
Mailing Address - Country:US
Mailing Address - Phone:859-353-3309
Mailing Address - Fax:
Practice Address - Street 1:501 CAPERTON DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-6508
Practice Address - Country:US
Practice Address - Phone:606-258-1509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY015610183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist