Healthcare Provider Details

I. General information

NPI: 1477842334
Provider Name (Legal Business Name): STEVEN SHELDON JAGDEO BSC. PHARM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2011
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11037 MARSH ROAD
BEALETON VA
22712
US

IV. Provider business mailing address

541 HIGHLAND TOWNE LN
WARRENTON VA
20186-2624
US

V. Phone/Fax

Practice location:
  • Phone: 540-439-9742
  • Fax:
Mailing address:
  • Phone: 540-439-9742
  • Fax: 540-439-2954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202208778
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: