Provider Demographics
NPI:1194717785
Name:MEDEIROS, JAN SHOWALTER (RPH)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:SHOWALTER
Last Name:MEDEIROS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:ANN
Other - Last Name:SHOWALTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:16447 OLD TIMBER RD
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-4891
Mailing Address - Country:US
Mailing Address - Phone:276-623-0801
Mailing Address - Fax:276-623-0812
Practice Address - Street 1:1 MEDICAL PARK BLVD
Practice Address - Street 2:SUITE 106E
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7430
Practice Address - Country:US
Practice Address - Phone:423-844-2888
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202009118183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist