Provider Demographics
NPI:1295162493
Name:CASBERG, JESSIE ZEPEDA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JESSIE
Middle Name:ZEPEDA
Last Name:CASBERG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:CAMPA
Other - Last Name:ZEPEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1270 KOT NUM ROAD
Mailing Address - Street 2:PO BOX 1209
Mailing Address - City:WARM SPRINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97761
Mailing Address - Country:US
Mailing Address - Phone:541-553-1196
Mailing Address - Fax:541-553-2481
Practice Address - Street 1:1270 KOT NUM ROAD
Practice Address - Street 2:
Practice Address - City:WARM SPRINGS
Practice Address - State:OR
Practice Address - Zip Code:97761
Practice Address - Country:US
Practice Address - Phone:541-553-1196
Practice Address - Fax:541-553-2481
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23244183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist