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General NPI Number Information
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NPI Number | 1073720132
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Entity Type | Individual
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Provider Name | LEONARD DWIGHT JESSEE PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 05/05/2009
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Provider Practice Location Address
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Address Line | 205 KILBOURNE AVENUE
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City | APPALACHIA
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State | VA
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Zip | 24216
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Country | US
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Telephone | 276-565-3434
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Fax | 276-565-0473
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Provider Business Mailing Address
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Address Line | PO BOX 469
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City | APPALACHIA
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State | VA
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Zip | 24216-0469
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Country | US
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Telephone | 276-565-3434
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Fax | 276-565-0473
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0202011765
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License Number State | VA
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