Provider Demographics
NPI:1508575499
Name:WEST, JESSICA LEANNE (RPH)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEANNE
Last Name:WEST
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 1:1200 HIGHWAY 74 S STE 20
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-3071
Mailing Address - Country:US
Mailing Address - Phone:770-486-5559
Mailing Address - Fax:
Practice Address - Street 1:1200 HIGHWAY 74 S STE 20
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-3071
Practice Address - Country:US
Practice Address - Phone:770-486-5559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH033918183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist