Provider Demographics
NPI:1477144368
Name:JESKE, KANDICE DAWN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KANDICE
Middle Name:DAWN
Last Name:JESKE
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 1:2027 CROSSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73025-1237
Mailing Address - Country:US
Mailing Address - Phone:405-863-2467
Mailing Address - Fax:
Practice Address - Street 1:WALGREENS PHARMACY #5530
Practice Address - Street 2:929 W OWEN K GARRIOTT RD
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701
Practice Address - Country:US
Practice Address - Phone:580-237-3151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR-13771183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist