Provider Demographics
NPI:1730299918
Name:CHINN, JESSIKA CHILTON (PHARMD)
Entity Type:Individual
Prefix:
First Name:JESSIKA
Middle Name:CHILTON
Last Name:CHINN
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 1:650 HEFLIN TRL
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:KY
Mailing Address - Zip Code:42320-1620
Mailing Address - Country:US
Mailing Address - Phone:270-417-6701
Mailing Address - Fax:270-417-6705
Practice Address - Street 1:1301 PLEASANT VALLEY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-9774
Practice Address - Country:US
Practice Address - Phone:270-417-6701
Practice Address - Fax:270-417-6705
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011872183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist