Provider Demographics
NPI:1376146514
Name:PIERCE, JESSICA (RPH)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PIERCE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 ELM ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-4335
Mailing Address - Country:US
Mailing Address - Phone:207-650-2300
Mailing Address - Fax:
Practice Address - Street 1:295 FOREST AVE # R
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2018
Practice Address - Country:US
Practice Address - Phone:207-885-2098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR45328183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist