Provider Demographics
NPI:1689008724
Name:D'AMOUR, JESSICA (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:D'AMOUR
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-1111
Mailing Address - Country:US
Mailing Address - Phone:716-885-9944
Mailing Address - Fax:
Practice Address - Street 1:1410 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1111
Practice Address - Country:US
Practice Address - Phone:716-885-9944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058314183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist