Provider Demographics
NPI:1891099313
Name:BLALOCK, JESSICA MORA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MORA
Last Name:BLALOCK
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 1:717 PAUL ST
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-4898
Mailing Address - Country:US
Mailing Address - Phone:804-687-1499
Mailing Address - Fax:
Practice Address - Street 1:850 STATLER BLVD
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-4880
Practice Address - Country:US
Practice Address - Phone:540-885-9875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-23
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207033183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist