MEDICARE: JESSICA HEATHCOTE RPH

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	26021106A	IN

General Provider Information

NPI Number	:	1306483169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA HEATHCOTE RPH

Provider Business Mailing Address
First Line	:	2200 GREENBUSH ST
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47904-2342
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 GREENBUSH ST
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47904-2342
Country	:	US
Telephone Number	:	765-474-8270
Fax Number	:

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

Provider Enumeration Date	:	11/28/2019
Last Update Date	:	06/04/2026

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