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General NPI Number Information
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NPI Number | 1811765696
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Entity Type | Individual
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Provider Name | KELLY NICOLE JEON
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Gender | Female
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Dates
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Enumeration Date | 12/12/2023
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Last Update Date | 12/12/2023
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Provider Practice Location Address
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Address Line | 1701 N GEORGE MASON DR
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City | ARLINGTON
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State | VA
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Zip | 22205-3610
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Country | US
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Telephone | 703-558-6217
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Fax |
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Provider Business Mailing Address
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Address Line | 8505 SUMMERSHADE DR
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City | ODENTON
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State | MD
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Zip | 21113-2281
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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 | 0202221710
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License Number State | VA
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