Provider Demographics
NPI:1558480384
Name:KASSELMAN, JENNIFER LEAKE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEAKE
Last Name:KASSELMAN
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 1:118 W BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:MS
Mailing Address - Zip Code:39330-9271
Mailing Address - Country:US
Mailing Address - Phone:601-616-5047
Mailing Address - Fax:
Practice Address - Street 1:231 EASTSIDE DR
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MS
Practice Address - Zip Code:39345-8035
Practice Address - Country:US
Practice Address - Phone:601-683-6117
Practice Address - Fax:601-683-3640
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21553183500000X
MO2000174381183500000X
MST-09906183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist