Provider Demographics
NPI:1174683619
Name:FAJNA, JILLIAN GRIZZARD (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:GRIZZARD
Last Name:FAJNA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 MEADOW BANK RD
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23847-7507
Mailing Address - Country:US
Mailing Address - Phone:434-634-3737
Mailing Address - Fax:
Practice Address - Street 1:328 W MAIN ST
Practice Address - Street 2:WAVERLY DRUGS
Practice Address - City:WAVERLY
Practice Address - State:VA
Practice Address - Zip Code:23890
Practice Address - Country:US
Practice Address - Phone:804-834-2233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011391183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist