Healthcare Provider Details

I. General information

NPI: 1205048188
Provider Name (Legal Business Name): JESSICA ELAINE RHODES CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 RIVER RD
PETERSBURG VA
23804
US

IV. Provider business mailing address

18709 CARTER RD
DINWIDDIE VA
23841-2109
US

V. Phone/Fax

Practice location:
  • Phone: 804-504-7200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number0230006558
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: