Provider Demographics
NPI:1467932194
Name:GALVAN, JESSICA ANN (RPH)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ANN
Last Name:GALVAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANN
Other - Last Name:FRANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2011 ADOBE AVE UNIT F
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:WY
Mailing Address - Zip Code:82633-3065
Mailing Address - Country:US
Mailing Address - Phone:307-358-1706
Mailing Address - Fax:
Practice Address - Street 1:1900 E RICHARDS ST
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:WY
Practice Address - Zip Code:82633-3029
Practice Address - Country:US
Practice Address - Phone:307-358-1706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4087183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist