Healthcare Provider Details

I. General information

NPI: 1851223572
Provider Name (Legal Business Name): JESSICA SMITH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 NW PLATTE RD
RIVERSIDE MO
64150-8800
US

IV. Provider business mailing address

3053 S LINWOOD AVE
INDEPENDENCE MO
64055-2937
US

V. Phone/Fax

Practice location:
  • Phone: 816-569-2125
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2025042308
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: