MEDICARE: MR. JAEAU SABIO OBCEMEA

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	183500000X	Pharmacist	0202215272	VA

General Provider Information

NPI Number	:	1851782304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAEAU SABIO OBCEMEA

Provider Business Mailing Address
First Line	:	2425 SUMMERWOOD DR
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23233-2417
Country	:	US
Telephone Number	:	703-400-0710
Fax Number	:

Provider Business Practice Location Address
First Line	:	2425 SUMMERWOOD DR
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23233-2417
Country	:	US
Telephone Number	:	703-400-0710
Fax Number	:

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

Provider Enumeration Date	:	02/05/2015
Last Update Date	:	12/04/2023

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