MEDICARE: KIEALA SHAJUWANDA JONES

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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1376233809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIEALA SHAJUWANDA JONES

Provider Business Mailing Address
First Line	:	6100 SHINGLEMAKER CT APT 102
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-4853
Country	:	US
Telephone Number	:	757-685-2122
Fax Number	:

Provider Business Practice Location Address
First Line	:	6100 SHINGLEMAKER CT APT 102
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-4853
Country	:	US
Telephone Number	:	757-235-7735
Fax Number	:

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

Provider Enumeration Date	:	05/09/2023
Last Update Date	:	05/09/2023

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