MEDICARE: MRS. JENNIFER BETH BAILEY JADALLAH 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
1	183500000X	Pharmacist	0202209326	VA

General Provider Information

NPI Number	:	1841508934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER BETH BAILEY JADALLAH PHARM.D.

Provider Business Mailing Address
First Line	:	1233 PROVIDENCE KNOLL DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23236-2174
Country	:	US
Telephone Number	:	804-928-6056
Fax Number	:

Provider Business Practice Location Address
First Line	:	4816 S LABURNUM AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23231-2714
Country	:	US
Telephone Number	:	804-226-0010
Fax Number	:	804-222-3755

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

Provider Enumeration Date	:	09/22/2010
Last Update Date	:	09/22/2010

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