Provider Demographics
NPI:1669679387
Name:SMITH, JESSICA BROOKS (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:BROOKS
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 1:305 FERRY AVE
Mailing Address - Street 2:
Mailing Address - City:COULEE DAM
Mailing Address - State:WA
Mailing Address - Zip Code:99116-1413
Mailing Address - Country:US
Mailing Address - Phone:509-431-4953
Mailing Address - Fax:
Practice Address - Street 1:320 MIDWAY AVE
Practice Address - Street 2:
Practice Address - City:GRAND COULEE
Practice Address - State:WA
Practice Address - Zip Code:99133
Practice Address - Country:US
Practice Address - Phone:509-431-4953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH000696591835P2201X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care