Healthcare Provider Details

I. General information

NPI: 1174445407
Provider Name (Legal Business Name): JESSICA PERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9700 HEALTH CARE LN
MINNETONKA MN
55343-4522
US

IV. Provider business mailing address

12509 BANNOCKBURN PL
OKLAHOMA CITY OK
73142-4516
US

V. Phone/Fax

Practice location:
  • Phone: 800-711-4555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15324
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: