Provider Demographics
NPI:1376825182
Name:GRASHAM, JESSICA MAE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MAE
Last Name:GRASHAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:MAE
Other - Last Name:GRESHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2418 BELL MANOR DR SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35803-3427
Mailing Address - Country:US
Mailing Address - Phone:256-783-9469
Mailing Address - Fax:
Practice Address - Street 1:2418 BELL MANOR DR SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35803-3427
Practice Address - Country:US
Practice Address - Phone:256-783-9469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16478183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL16478OtherAL STATE BOARD OF PHARMACY LICENSE