MEDICARE: MR. URISH JEROS 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	183500000X	Pharmacist	0202205645	VA

General Provider Information

NPI Number	:	1881696235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. URISH JEROS PHARMACIST

Provider Business Mailing Address
First Line	:	2975 WILLOW TRACE LN
Second Line	:
City	:	SANDY HOOK
State	:	VA
Zip	:	23153-2252
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7127 STAPLES MILL RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23228-4110
Country	:	US
Telephone Number	:	804-264-2516
Fax Number	:	804-264-9077

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	07/08/2007

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