Provider Demographics
NPI:1578763736
Name:WELLMAN, JESSICA CLARK (PHARMD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:CLARK
Last Name:WELLMAN
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 1:600 N WOLFE ST
Mailing Address - Street 2:CARNEGIE 180
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-5703
Mailing Address - Country:US
Mailing Address - Phone:410-614-1566
Mailing Address - Fax:410-614-8601
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:CARNEGIE 180
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-5703
Practice Address - Country:US
Practice Address - Phone:410-614-1566
Practice Address - Fax:410-614-8601
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11803183500000X
MD188221835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist