Provider Demographics
NPI:1265739569
Name:WIRTZ, JESSICA LYNN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LYNN
Last Name:WIRTZ
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:NORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:701 N STATE HIGHWAY 47
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63383-1119
Mailing Address - Country:US
Mailing Address - Phone:636-377-2172
Mailing Address - Fax:
Practice Address - Street 1:701 N STATE HIGHWAY 47
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383-1119
Practice Address - Country:US
Practice Address - Phone:636-377-2172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-22
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013005452183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist