Provider Demographics
NPI:1932495017
Name:ROBERTSON, JESSICA DAVIS (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:DAVIS
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:RENEE'
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:7942 WINCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-2306
Mailing Address - Country:US
Mailing Address - Phone:901-758-3615
Mailing Address - Fax:901-758-3616
Practice Address - Street 1:7942 WINCHESTER RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-2306
Practice Address - Country:US
Practice Address - Phone:901-758-3615
Practice Address - Fax:901-758-3616
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33735183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist