Provider Demographics
NPI:1215033733
Name:O'NEILL, JESSICA LEE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LEE
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:LEE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:710 BREAKWATER DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-4471
Mailing Address - Country:US
Mailing Address - Phone:734-769-7100
Mailing Address - Fax:734-761-5590
Practice Address - Street 1:2215 FULLER RD # 119
Practice Address - Street 2:PHARMACY SERVICES
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2335
Practice Address - Country:US
Practice Address - Phone:734-769-7100
Practice Address - Fax:734-761-5590
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032609183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist