Provider Demographics
NPI:1619262094
Name:SPEERS, JESSICA M (PHARMD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:SPEERS
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 1:111 PIONEER TRL
Mailing Address - Street 2:T-1352
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318
Mailing Address - Country:US
Mailing Address - Phone:952-361-3766
Mailing Address - Fax:952-361-3766
Practice Address - Street 1:111 PIONEER TRL
Practice Address - Street 2:T-1352
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318
Practice Address - Country:US
Practice Address - Phone:952-361-3766
Practice Address - Fax:952-361-3766
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119326183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist