Healthcare Provider Details

I. General information

NPI: 1336359215
Provider Name (Legal Business Name): JAYKUMAR A AGARWAL RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 BATTLEFIELD BLVD N
CHESAPEAKE VA
23320-4871
US

IV. Provider business mailing address

716 WILLOW BROOK RD
CHESAPEAKE VA
23320-3563
US

V. Phone/Fax

Practice location:
  • Phone: 757-382-9717
  • Fax:
Mailing address:
  • Phone: 718-440-5313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202206806
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: