Provider Demographics
NPI:1336407980
Name:DEVASIA, JESSICA MARIA (PHARMD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIA
Last Name:DEVASIA
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 1:5769 LONE TREE WAY
Mailing Address - Street 2:T-1819
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8587
Mailing Address - Country:US
Mailing Address - Phone:925-752-0002
Mailing Address - Fax:
Practice Address - Street 1:5769 LONE TREE WAY
Practice Address - Street 2:T-1819
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-8587
Practice Address - Country:US
Practice Address - Phone:925-752-0002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65668183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist