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General NPI Number Information
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NPI Number | 1245412964
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Entity Type | Individual
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Provider Name | JODI V. ETTARE PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 12/04/2007
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Provider Practice Location Address
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Address Line | 22776 TIMBERLAKE RD SUITE C
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City | LYNCHBURG
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State | VA
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Zip | 24502-7310
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Country | US
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Telephone | 434-237-3331
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Fax | 434-237-3313
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Provider Business Mailing Address
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Address Line | 194 N LAKE DR
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City | LYNCHBURG
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State | VA
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Zip | 24502-6661
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Country | US
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Telephone | 434-525-5131
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Fax |
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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 | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 0202205862
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License Number State | VA
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