Healthcare Provider Details

I. General information

NPI: 1447929674
Provider Name (Legal Business Name): JESSICA CHIDERA IHEM RPH., PHARMD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2021
Last Update Date: 09/10/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4641-51 CHESTNUT STREET
PHILADELPHIA PA
19139
US

IV. Provider business mailing address

335 INDEPENDENCE AVE
HAMILTON NJ
08610-5703
US

V. Phone/Fax

Practice location:
  • Phone: 215-474-5447
  • Fax:
Mailing address:
  • Phone: 609-369-4527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP455568
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: