Provider Demographics
NPI:1669150504
Name:DOHERTY, JESSICA KRISTINE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:KRISTINE
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:KRISTINE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2900 12TH AVE N STE 503E
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-7502
Mailing Address - Country:US
Mailing Address - Phone:406-237-5780
Mailing Address - Fax:406-237-5785
Practice Address - Street 1:2900 12TH AVE N STE 503E
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-7502
Practice Address - Country:US
Practice Address - Phone:406-237-5780
Practice Address - Fax:406-237-5785
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRPH5976183500000X
MTPHA-PHA-LIC-549191835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist