Provider Demographics
NPI:1427304492
Name:HOPPER, JESSICA EMILY (PHARMD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:EMILY
Last Name:HOPPER
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 1:1860 S 2ND AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-6872
Mailing Address - Country:US
Mailing Address - Phone:307-399-5024
Mailing Address - Fax:
Practice Address - Street 1:529 W LAS PALMARITAS DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-5534
Practice Address - Country:US
Practice Address - Phone:307-399-5024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS0215781835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric