Healthcare Provider Details

I. General information

NPI: 1881696235
Provider Name (Legal Business Name): URISH JEROS PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7127 STAPLES MILL RD
RICHMOND VA
23228-4110
US

IV. Provider business mailing address

2975 WILLOW TRACE LN
SANDY HOOK VA
23153-2252
US

V. Phone/Fax

Practice location:
  • Phone: 804-264-2516
  • Fax: 804-264-9077
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202205645
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: