Provider Demographics
NPI:1598040172
Name:KLUNK, JESSICA ANN (PHARMD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:KLUNK
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 1:1138 MURPHY LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-5903
Mailing Address - Country:US
Mailing Address - Phone:412-400-1291
Mailing Address - Fax:
Practice Address - Street 1:2912 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALKERTOWN
Practice Address - State:NC
Practice Address - Zip Code:27051-9324
Practice Address - Country:US
Practice Address - Phone:336-595-2638
Practice Address - Fax:336-595-7569
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22102183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist