Healthcare Provider Details

I. General information

NPI: 1033731658
Provider Name (Legal Business Name): JESSICA MARIE JUDEH PHARM. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. JESSICA MARIE JUDEH

II. Dates (important events)

Enumeration Date: 05/18/2020
Last Update Date: 05/18/2020
Certification Date: 05/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

569 S HIGH ST
CORTLAND OH
44410-1506
US

IV. Provider business mailing address

115 GLENEAGLE
CORTLAND OH
44410-8729
US

V. Phone/Fax

Practice location:
  • Phone: 330-638-8747
  • Fax:
Mailing address:
  • Phone: 330-501-7322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03328421
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: