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General NPI Number Information
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NPI Number | 1154926269
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Entity Type | Individual
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Provider Name | PHYDARIEL LAVERNE JONES PHARMD
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Gender | Female
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Dates
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Enumeration Date | 12/04/2020
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Last Update Date | 12/04/2020
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Provider Practice Location Address
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Address Line | 7501 HUNTSMAN BLVD
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City | SPRINGFIELD
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State | VA
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Zip | 22153-1649
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Country | US
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Telephone | 703-866-2336
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Fax | 844-411-6539
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Provider Business Mailing Address
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Address Line | 13315 PACKARD DR
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City | WOODBRIDGE
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State | VA
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Zip | 22193-3959
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Country | US
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Telephone | 703-967-9102
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Fax | 703-680-6570
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0202012131
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License Number State | VA
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