MEDICARE: JESSICA PHAM PHARM D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	RPH019249	GA
2	183500000X	Pharmacist	RPH019249	GA

General Provider Information

NPI Number	:	1730787391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA PHAM PHARM D

Provider Business Mailing Address
First Line	:	950 HERRINGTON RD
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-7217
Country	:	US
Telephone Number	:	770-995-6210
Fax Number	:	770-962-3684

Provider Business Practice Location Address
First Line	:	950 HERRINGTON RD
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-7217
Country	:	US
Telephone Number	:	770-995-6210
Fax Number	:	770-962-3684

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2020
Last Update Date	:	05/28/2026

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Directions to “ JESSICA PHAM PHARM D” Practice Location

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