Provider Demographics
NPI:1700055803
Name:HERR, JESSICA D (PHARMD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:D
Last Name:HERR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:D
Other - Last Name:LEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:716 COLLINS AVE
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-5649
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1301 SKIPPACK PIKE
Practice Address - Street 2:
Practice Address - City:CENTER SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19422-1254
Practice Address - Country:US
Practice Address - Phone:610-279-2332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP045180L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP045180LOtherSTATE LICENSE NUMBER