Provider Demographics
NPI:1427834894
Name:CAMERON, JESSICA LYNN (PHARMD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:CAMERON
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 1:701 W 101ST PL S APT 428
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-3512
Mailing Address - Country:US
Mailing Address - Phone:918-978-3598
Mailing Address - Fax:
Practice Address - Street 1:3900 E HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74014-6713
Practice Address - Country:US
Practice Address - Phone:918-355-1076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20193183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist