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General NPI Number Information
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NPI Number | 1972161636
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Entity Type | Individual
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Provider Name | JESSICA SUZANNE SHOWEN PHARMD
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Gender | Female
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Dates
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Enumeration Date | 05/29/2019
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Last Update Date | 05/29/2019
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Provider Practice Location Address
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Address Line | 106 BROADWAY ST STE A
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City | ELSBERRY
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State | MO
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Zip | 63343-1345
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Country | US
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Telephone | 573-898-2550
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Fax |
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Provider Business Mailing Address
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Address Line | 9906 WARSHIRE DR
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City | SAINT LOUIS
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State | MO
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Zip | 63132-2917
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Country | US
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Telephone | 618-406-1208
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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 | 2017041668
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License Number State | MO
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