Provider Demographics
NPI:1962007898
Name:REYES, JESSICA (PHARM D)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14701 PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:IL
Mailing Address - Zip Code:60445-3410
Mailing Address - Country:US
Mailing Address - Phone:708-239-2150
Mailing Address - Fax:
Practice Address - Street 1:14701 PULASKI RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:IL
Practice Address - Zip Code:60445-3410
Practice Address - Country:US
Practice Address - Phone:708-239-2150
Practice Address - Fax:708-239-2156
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051300733183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist