Healthcare Provider Details

I. General information

NPI: 1457216806
Provider Name (Legal Business Name): JESSICA CONNIE WILSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA CONNIE HECKMAN PHARMD

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 ELMWOOD AVE
ROCHESTER NY
14620-3005
US

IV. Provider business mailing address

5293 EMERSON RD LOWR APT
CANANDAIGUA NY
14424-8012
US

V. Phone/Fax

Practice location:
  • Phone: 585-447-0777
  • Fax:
Mailing address:
  • Phone: 585-447-0777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number071991
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: