Provider Demographics
NPI:1154926269
Name:JONES, PHYDARIEL LAVERNE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:PHYDARIEL
Middle Name:LAVERNE
Last Name:JONES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13315 PACKARD DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-3959
Mailing Address - Country:US
Mailing Address - Phone:703-967-9102
Mailing Address - Fax:703-680-6570
Practice Address - Street 1:7501 HUNTSMAN BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22153-1649
Practice Address - Country:US
Practice Address - Phone:703-866-2336
Practice Address - Fax:844-411-6539
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202012131183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist