Provider Demographics
NPI:1780992461
Name:AMBROSE, JESSICA (PHARMD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:AMBROSE
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 1:120 W MARTIN LUTHER KING JR DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-4906
Mailing Address - Country:US
Mailing Address - Phone:252-943-6260
Mailing Address - Fax:
Practice Address - Street 1:418 US HIGHWAY 264 BYP
Practice Address - Street 2:
Practice Address - City:BELHAVEN
Practice Address - State:NC
Practice Address - Zip Code:27810-9291
Practice Address - Country:US
Practice Address - Phone:252-943-6260
Practice Address - Fax:252-944-0095
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist