MEDICARE: DR. NICHOLAS EVERETT JESTER PHARMD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	0202215967	VA

General Provider Information

NPI Number	:	1497381032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS EVERETT JESTER PHARMD.

Provider Business Mailing Address
First Line	:	128 LAWSON DR
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23693-3205
Country	:	US
Telephone Number	:	757-593-8685
Fax Number	:

Provider Business Practice Location Address
First Line	:	5007 VICTORY BLVD STE 2
Second Line	:
City	:	TABB
State	:	VA
Zip	:	23693-5606
Country	:	US
Telephone Number	:	757-234-7982
Fax Number	:	757-234-7984

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2020
Last Update Date	:	03/16/2020

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