Provider Demographics
NPI:1215090857
Name:VISCO, JESSICA L (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:L
Last Name:VISCO
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 1:110 HOGAN WOODS CIR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-4317
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:406 RIGSBEE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-2186
Practice Address - Country:US
Practice Address - Phone:919-688-4772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC160291835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric