Provider Demographics
NPI:1467006098
Name:ATKINS, JACKLYN (PHARM D)
Entity Type:Individual
Prefix:
First Name:JACKLYN
Middle Name:
Last Name:ATKINS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8811 FOREST HILL AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-2433
Mailing Address - Country:US
Mailing Address - Phone:804-320-7367
Mailing Address - Fax:
Practice Address - Street 1:8811 FOREST HILL AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-2433
Practice Address - Country:US
Practice Address - Phone:804-320-7367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202217976183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist