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General NPI Number Information
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NPI Number | 1942941554
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Entity Type | Individual
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Provider Name | JACKIE OWEN RPH
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Gender | Female
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Dates
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Enumeration Date | 04/06/2022
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Last Update Date | 04/12/2022
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Provider Practice Location Address
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Address Line | 4720B LEE HWY
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City | ARLINGTON
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State | VA
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Zip | 22207-3417
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Country | US
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Telephone | 703-524-9003
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Fax |
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Provider Business Mailing Address
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Address Line | 5010A BARBOUR DR
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City | ALEXANDRIA
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State | VA
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Zip | 22304-7709
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Country | US
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Telephone | 217-251-7122
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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 | 0202220203
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License Number State | VA
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