Provider Demographics
NPI:1386124568
Name:HOWARD, JESSICA
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:HOWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 EDGE HILL DR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-5817
Mailing Address - Country:US
Mailing Address - Phone:518-420-7994
Mailing Address - Fax:
Practice Address - Street 1:701 HAWLEY AVE
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-3382
Practice Address - Country:US
Practice Address - Phone:704-825-8188
Practice Address - Fax:704-825-8891
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12315183500000X
NC19765183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist