Provider Demographics
NPI:1750649950
Name:RODERY, JESSICA LOUISE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LOUISE
Last Name:RODERY
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 1:1718 MARSH RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4606
Mailing Address - Country:US
Mailing Address - Phone:302-478-7200
Mailing Address - Fax:302-478-3534
Practice Address - Street 1:1718 MARSH RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4606
Practice Address - Country:US
Practice Address - Phone:302-478-7200
Practice Address - Fax:302-478-3534
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0004111183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA117611065001OtherBLUE CROSS BLUE SHIELD