MEDICARE: JESSICA KATE MCEVER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician

General Provider Information

NPI Number	:	1104400829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA KATE MCEVER

Provider Business Mailing Address
First Line	:	10248 OLD NACHES HWY
Second Line	:
City	:	NACHES
State	:	WA
Zip	:	98937-9700
Country	:	US
Telephone Number	:	509-929-3001
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 S MAIN ST
Second Line	:
City	:	ELLENSBURG
State	:	WA
Zip	:	98926-3641
Country	:	US
Telephone Number	:	509-925-4232
Fax Number	:	509-925-6063

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2021
Last Update Date	:	05/09/2021

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Directions to “ JESSICA KATE MCEVER ” Practice Location

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