Provider Demographics
NPI:1245886928
Name:SMITH, JESSICA DAWN (PHARMD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DAWN
Last Name:SMITH
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 1:950 S PERU ST
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IN
Mailing Address - Zip Code:46034-9610
Mailing Address - Country:US
Mailing Address - Phone:317-984-3623
Mailing Address - Fax:317-984-7603
Practice Address - Street 1:950 S PERU ST
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IN
Practice Address - Zip Code:46034-9610
Practice Address - Country:US
Practice Address - Phone:317-984-3623
Practice Address - Fax:317-984-7603
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-17
Last Update Date:2019-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26026560A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist