=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477842334
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN SHELDON JAGDEO BSC. PHARM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2011
-----------------------------------------------------
Last Update Date | 03/31/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11037 MARSH ROAD
-----------------------------------------------------
City | BEALETON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-439-9742
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 541 HIGHLAND TOWNE LN
-----------------------------------------------------
City | WARRENTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20186-2624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-439-9742
-----------------------------------------------------
Fax | 540-439-2954
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 0202208778
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------