Provider Demographics
NPI:1972062297
Name:ROHAN, JESSICA RYAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RYAN
Last Name:ROHAN
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 1:32000 WALLINGTON CT
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-4135
Mailing Address - Country:US
Mailing Address - Phone:502-298-1936
Mailing Address - Fax:
Practice Address - Street 1:1018 CASITAS PASS RD
Practice Address - Street 2:
Practice Address - City:CARPINTERIA
Practice Address - State:CA
Practice Address - Zip Code:93013-2109
Practice Address - Country:US
Practice Address - Phone:805-684-8367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-16
Last Update Date:2019-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist