Healthcare Provider Details

I. General information

NPI: 1790074557
Provider Name (Legal Business Name): JESSICA R HORRELL PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 04/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 NORTH HIGHWAY 20
HINES OR
97738
US

IV. Provider business mailing address

PO BOX 585
HINES OR
97738-0585
US

V. Phone/Fax

Practice location:
  • Phone: 541-573-1523
  • Fax: 541-573-1502
Mailing address:
  • Phone: 541-573-1523
  • Fax: 541-573-1502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0011136
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: