Provider Demographics
NPI:1790024206
Name:CLINGER, JESSE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:
Last Name:CLINGER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 ATLANTIS CT APT 7
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6433
Mailing Address - Country:US
Mailing Address - Phone:801-529-2968
Mailing Address - Fax:
Practice Address - Street 1:5098 SOUTHPORT SUPPLY RD SE
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-8746
Practice Address - Country:US
Practice Address - Phone:910-457-1463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22437183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist