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General NPI Number Information
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NPI Number | 1386304202
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Entity Type | Individual
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Provider Name | JESSA CLAIRE BIBB
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Gender | Female
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Dates
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Enumeration Date | 12/20/2021
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Last Update Date | 12/20/2021
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Provider Practice Location Address
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Address Line | 6697 STAGE RD
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City | BARTLETT
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State | TN
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Zip | 38134-3867
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Country | US
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Telephone | 901-373-6498
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Fax |
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Provider Business Mailing Address
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Address Line | 398 HOLLY GROVE RD
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City | COVINGTON
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State | TN
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Zip | 38019-3617
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Country | US
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Telephone | 901-389-8601
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Fax |
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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 | 0000044595
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License Number State | TN
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