Provider Demographics
NPI:1427427855
Name:VALENTINE, JASON RANDOLPH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:RANDOLPH
Last Name:VALENTINE
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 1:19 OAK TREE LN
Mailing Address - Street 2:APARTMENT 203
Mailing Address - City:STUARTS DRAFT
Mailing Address - State:VA
Mailing Address - Zip Code:24477-2719
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:465 LEE HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:VERONA
Practice Address - State:VA
Practice Address - Zip Code:24482
Practice Address - Country:US
Practice Address - Phone:540-248-0307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202213948183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist