Provider Demographics
NPI:1467843979
Name:LICHT, JAYME
Entity Type:Individual
Prefix:
First Name:JAYME
Middle Name:
Last Name:LICHT
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 1:1090 STAFFORD MARKET PL
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-4523
Mailing Address - Country:US
Mailing Address - Phone:540-658-9927
Mailing Address - Fax:540-628-7418
Practice Address - Street 1:1090 STAFFORD MARKET PL
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-4523
Practice Address - Country:US
Practice Address - Phone:540-658-9927
Practice Address - Fax:540-628-7418
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230019517183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician