Provider Demographics
NPI:1659619237
Name:OLIVER, JESSICA (PHARM D)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4840 GOLDEN PKWY
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-5843
Mailing Address - Country:US
Mailing Address - Phone:770-614-7711
Mailing Address - Fax:
Practice Address - Street 1:4840 GOLDEN PKWY
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-5843
Practice Address - Country:US
Practice Address - Phone:770-614-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA026008183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist