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General NPI Number Information
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NPI Number | 1477144368
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Entity Type | Individual
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Provider Name | KANDICE DAWN JESKE PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 02/02/2021
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Last Update Date | 02/02/2021
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Provider Practice Location Address
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Address Line | WALGREENS PHARMACY #5530 929 W OWEN K GARRIOTT RD
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City | ENID
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State | OK
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Zip | 73701
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Country | US
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Telephone | 580-237-3151
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Fax |
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Provider Business Mailing Address
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Address Line | 2027 CROSSFIELD DR
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City | EDMOND
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State | OK
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Zip | 73025-1237
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Country | US
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Telephone | 405-863-2467
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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 | R-13771
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License Number State | OK
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