Provider Demographics
NPI:1194608307
Name:BRISTER, JEFFERY (PHARMD)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:
Last Name:BRISTER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 RIVERMONT HTS
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-5015
Mailing Address - Country:US
Mailing Address - Phone:276-224-7809
Mailing Address - Fax:
Practice Address - Street 1:1620 RIVERMONT HTS
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-5015
Practice Address - Country:US
Practice Address - Phone:276-224-7809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33961183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist