Provider Demographics
NPI:1447582606
Name:MAURER, JESSICA M (PHARMD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:MAURER
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 1:1240 STATE ROUTE 26
Mailing Address - Street 2:
Mailing Address - City:WEST LEYDEN
Mailing Address - State:NY
Mailing Address - Zip Code:13489-0088
Mailing Address - Country:US
Mailing Address - Phone:315-942-4751
Mailing Address - Fax:
Practice Address - Street 1:261 UTICA BLVD
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:NY
Practice Address - Zip Code:13309
Practice Address - Country:US
Practice Address - Phone:315-942-2509
Practice Address - Fax:315-942-3601
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051050183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist