Provider Demographics
NPI:1184059313
Name:FANN, JESSICA BLAIR (PHARMD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:BLAIR
Last Name:FANN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:BLAIR
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3304 CASTLE CREST DR
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-4221
Mailing Address - Country:US
Mailing Address - Phone:731-610-8613
Mailing Address - Fax:
Practice Address - Street 1:2817 30TH AVE N
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35207-4541
Practice Address - Country:US
Practice Address - Phone:731-610-8613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20491183500000X
TN37583183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist