Provider Demographics
NPI:1437582269
Name:LABODA, JESSICA MAE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MAE
Last Name:LABODA
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 1:6 RED JONATHAN CT
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-6386
Mailing Address - Country:US
Mailing Address - Phone:864-205-8272
Mailing Address - Fax:
Practice Address - Street 1:1801 POINSETT HWY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-2850
Practice Address - Country:US
Practice Address - Phone:864-240-8141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14332183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist