Provider Demographics
NPI:1336764687
Name:WALKUP, JESSICA ANNE
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ANNE
Last Name:WALKUP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANNE
Other - Last Name:LANGHALS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5177 SHOSHONE TRL
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-4117
Mailing Address - Country:US
Mailing Address - Phone:419-890-7252
Mailing Address - Fax:
Practice Address - Street 1:1550 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-2823
Practice Address - Country:US
Practice Address - Phone:419-812-2170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03234050183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist