Healthcare Provider Details

I. General information

NPI: 1477144368
Provider Name (Legal Business Name): KANDICE DAWN JESKE PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 02/02/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WALGREENS PHARMACY #5530 929 W OWEN K GARRIOTT RD
ENID OK
73701
US

IV. Provider business mailing address

2027 CROSSFIELD DR
EDMOND OK
73025-1237
US

V. Phone/Fax

Practice location:
  • Phone: 580-237-3151
  • Fax:
Mailing address:
  • Phone: 405-863-2467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberR-13771
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: