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NPI Code Detail

MEDICARE: DR. JESSICA ROSE WALBY PHARM.D.

MEDICARE: DR. JESSICA ROSE WALBY PHARM.D.
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
1183500000XPharmacistS017528AZ
2183500000XPharmacist5302039180MI
3183500000XPharmacist051293029IL

General Provider Information

NPI Number : 1518251388
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JESSICA ROSE WALBY PHARM.D.
Provider Business Mailing Address
First Line : 4734 E RAY RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85044-6225
Country : US
Telephone Number : 480-893-0588
Fax Number :
Provider Business Practice Location Address
First Line : 4734 E RAY RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85044-6225
Country : US
Telephone Number : 480-893-0588
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2011
Last Update Date : 06/08/2011

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