Provider Demographics
NPI:1447907092
Name:FEAMMELLI, JESSE ADAM (PHARMD)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:ADAM
Last Name:FEAMMELLI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:JESSE
Other - Middle Name:ADAM
Other - Last Name:FEAMMELLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1350 MIDVALE AVE APT 304
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-6342
Mailing Address - Country:US
Mailing Address - Phone:503-347-3092
Mailing Address - Fax:
Practice Address - Street 1:757 WESTWOOD PLZ
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-8358
Practice Address - Country:US
Practice Address - Phone:310-267-8538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76964183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist