Healthcare Provider Details

I. General information

NPI: 1619402518
Provider Name (Legal Business Name): JESSICA PEARL WENTE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA PEARL BURKS

II. Dates (important events)

Enumeration Date: 04/28/2017
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1094 N MAIN ST
BOWLING GREEN OH
43402-1346
US

IV. Provider business mailing address

1094 N MAIN ST
BOWLING GREEN OH
43402-1346
US

V. Phone/Fax

Practice location:
  • Phone: 419-353-5116
  • Fax: 419-353-5216
Mailing address:
  • Phone: 419-353-5116
  • Fax: 419-353-5216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03334455
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03334455
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: