MEDICARE: NASTAZHA JEAN DAVIS PHARMACIST

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	0202222308	VA

General Provider Information

NPI Number	:	1700612868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NASTAZHA JEAN DAVIS PHARMACIST

Provider Business Mailing Address
First Line	:	11895 W BROAD ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23233-1065
Country	:	US
Telephone Number	:	804-360-3268
Fax Number	:

Provider Business Practice Location Address
First Line	:	11895 W BROAD ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23233-1065
Country	:	US
Telephone Number	:	804-360-3268
Fax Number	:

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

Provider Enumeration Date	:	09/13/2024
Last Update Date	:	06/02/2026

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