Provider Demographics
NPI:1578859492
Name:TREADWAY, JESSICA (PHARMD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:TREADWAY
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 1:80 DAMANTE DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-5759
Mailing Address - Country:US
Mailing Address - Phone:603-227-0816
Mailing Address - Fax:603-573-9128
Practice Address - Street 1:80 DAMANTE DR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5759
Practice Address - Country:US
Practice Address - Phone:603-227-0816
Practice Address - Fax:603-573-9128
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHR2411183500000X
OH03127200-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist