Provider Demographics
NPI:1891311841
Name:MARSH, JESSICA (PHARMD, MBA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MARSH
Suffix:
Gender:F
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3940 GRESHAM ST UNIT 111
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-5807
Mailing Address - Country:US
Mailing Address - Phone:760-703-2540
Mailing Address - Fax:
Practice Address - Street 1:7200 PARKWAY DR STE 104
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-1534
Practice Address - Country:US
Practice Address - Phone:619-303-3572
Practice Address - Fax:619-303-3623
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80305183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty