Provider Demographics
NPI:1619213881
Name:CONKLIN, JESSICA RACHELLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:RACHELLE
Last Name:CONKLIN
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 1:1036 CASA ROJA PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-6587
Mailing Address - Country:US
Mailing Address - Phone:505-320-3764
Mailing Address - Fax:
Practice Address - Street 1:1036 CASA ROJA PL NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-6587
Practice Address - Country:US
Practice Address - Phone:505-320-3764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP000076981835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric