Individual
JARED STREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
110 W MAIN ST STE 1, LEBANON, VA 24266-4560
(276) 889-1919
Mailing address
110 W MAIN ST STE 1, LEBANON, VA 24266-4560
(276) 889-1919
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0202208559
VA
Other
Enumeration date
01/18/2022
Last updated
01/18/2022
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