Healthcare Provider Details

I. General information

NPI: 1780992461
Provider Name (Legal Business Name): JESSICA AMBROSE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 US HIGHWAY 264 BYP
BELHAVEN NC
27810-9291
US

IV. Provider business mailing address

120 W MARTIN LUTHER KING JR DR
WASHINGTON NC
27889-4906
US

V. Phone/Fax

Practice location:
  • Phone: 252-943-6260
  • Fax: 252-944-0095
Mailing address:
  • Phone: 252-943-6260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21096
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: