Provider Demographics
NPI:1326348855
Name:KACHRU, JYOTSNA
Entity Type:Individual
Prefix:
First Name:JYOTSNA
Middle Name:
Last Name:KACHRU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11120 S LAKES DR
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-4327
Mailing Address - Country:US
Mailing Address - Phone:703-620-2444
Mailing Address - Fax:703-758-1578
Practice Address - Street 1:11120 S LAKES DR
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-4327
Practice Address - Country:US
Practice Address - Phone:703-620-2444
Practice Address - Fax:703-758-1578
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207762183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist