Individual
JAZZMINE ELAYNE WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
80 WESTLAKE RD, HARDY, VA 24101-3954
(540) 721-3102
Mailing address
3381 GLADE CREEK BLVD NE APT 9, ROANOKE, VA 24012-8671
(843) 473-5827
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0202216949
VA
Other
Enumeration date
01/02/2019
Last updated
01/02/2019
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