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General NPI Number Information
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NPI Number | 1740885300
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Entity Type | Individual
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Provider Name | JAISON DANIEL PERDUE PHARMD
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Gender | Male
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Dates
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Enumeration Date | 12/02/2020
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Last Update Date | 12/02/2020
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Provider Practice Location Address
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Address Line | 36115 GOODWIN DR
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City | LOCUST GROVE
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State | VA
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Zip | 22508-2029
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Country | US
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Telephone | 703-268-8463
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Fax |
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Provider Business Mailing Address
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Address Line | 36115 GOODWIN DR
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City | LOCUST GROVE
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State | VA
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Zip | 22508-2029
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Country | US
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Telephone |
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0202210088
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License Number State | VA
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