Provider Demographics
NPI:1497381032
Name:JESTER, NICHOLAS EVERETT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:EVERETT
Last Name:JESTER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 LAWSON DR
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-3205
Mailing Address - Country:US
Mailing Address - Phone:757-593-8685
Mailing Address - Fax:
Practice Address - Street 1:5007 VICTORY BLVD STE 2
Practice Address - Street 2:
Practice Address - City:TABB
Practice Address - State:VA
Practice Address - Zip Code:23693-5606
Practice Address - Country:US
Practice Address - Phone:757-234-7982
Practice Address - Fax:757-234-7984
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02022159671835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist