Provider Demographics
NPI:1831163062
Name:STERN, JESSICA L (PHA, LMP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:STERN
Suffix:
Gender:F
Credentials:PHA, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50764
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98015-0764
Mailing Address - Country:US
Mailing Address - Phone:253-850-9973
Mailing Address - Fax:253-850-1405
Practice Address - Street 1:524 W MEEKER ST
Practice Address - Street 2:STE 4
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-5766
Practice Address - Country:US
Practice Address - Phone:253-850-9973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00020719183700000X
WAMA 00010679174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No174400000XOther Service ProvidersSpecialist