Provider Demographics
NPI:1518251388
Name:WALBY, JESSICA ROSE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ROSE
Last Name:WALBY
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 1:4734 E RAY RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-6225
Mailing Address - Country:US
Mailing Address - Phone:480-893-0588
Mailing Address - Fax:
Practice Address - Street 1:4734 E RAY RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-6225
Practice Address - Country:US
Practice Address - Phone:480-893-0588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS017528183500000X
MI5302039180183500000X
IL051293029183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist