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General NPI Number Information
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NPI Number | 1558480384
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Entity Type | Individual
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Provider Name | JENNIFER LEAKE KASSELMAN PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 11/01/2023
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Provider Practice Location Address
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Address Line | 231 EASTSIDE DR
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City | NEWTON
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State | MS
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Zip | 39345-8035
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Country | US
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Telephone | 601-683-6117
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Fax | 601-683-3640
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Provider Business Mailing Address
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Address Line | 118 W BRIDGE ST
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City | ENTERPRISE
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State | MS
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Zip | 39330-9271
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Country | US
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Telephone | 601-616-5047
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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 | 21553
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2000174381
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | T-09906
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License Number State | MS
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