Provider Demographics
NPI:1306440565
Name:JACKSON, VALERIE DENISE (PHARMACIST)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:DENISE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 MAHER CT
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-5937
Mailing Address - Country:US
Mailing Address - Phone:301-292-9891
Mailing Address - Fax:301-292-9891
Practice Address - Street 1:6360 SEVEN CORNERS CTR
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2409
Practice Address - Country:US
Practice Address - Phone:703-534-6688
Practice Address - Fax:703-534-6683
Is Sole Proprietor?:No
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02020063131835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care