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General NPI Number Information
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NPI Number | 1851782304
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Entity Type | Individual
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Provider Name | MR. JAEAU SABIO OBCEMEA
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Gender | Male
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Dates
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Enumeration Date | 02/05/2015
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 2425 SUMMERWOOD DR
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City | HENRICO
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State | VA
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Zip | 23233-2417
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Country | US
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Telephone | 703-400-0710
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Fax |
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Provider Business Mailing Address
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Address Line | 2425 SUMMERWOOD DR
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City | HENRICO
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State | VA
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Zip | 23233-2417
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Country | US
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Telephone | 703-400-0710
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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 | 0202215272
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License Number State | VA
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