Provider Demographics
NPI:1477842334
Name:JAGDEO, STEVEN SHELDON (BSC PHARM)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:SHELDON
Last Name:JAGDEO
Suffix:
Gender:M
Credentials:BSC PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 HIGHLAND TOWNE LN
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-2624
Mailing Address - Country:US
Mailing Address - Phone:540-439-9742
Mailing Address - Fax:540-439-2954
Practice Address - Street 1:11037 MARSH ROAD
Practice Address - Street 2:
Practice Address - City:BEALETON
Practice Address - State:VA
Practice Address - Zip Code:22712
Practice Address - Country:US
Practice Address - Phone:540-439-9742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202208778183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202208778OtherSTATE LICENSE