Provider Demographics
NPI:1891161063
Name:LUEBSHAW, JESSICA
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:LUEBSHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1942 COLT DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-9241
Mailing Address - Country:US
Mailing Address - Phone:270-366-9348
Mailing Address - Fax:
Practice Address - Street 1:1942 COLT DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IL
Practice Address - Zip Code:61571-9241
Practice Address - Country:US
Practice Address - Phone:270-366-9348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.297565183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist