Provider Demographics
NPI:1548779010
Name:CHAPPELL, JACKSON LAYNE (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:JACKSON
Middle Name:LAYNE
Last Name:CHAPPELL
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 NORGE LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-7230
Mailing Address - Country:US
Mailing Address - Phone:757-564-8627
Mailing Address - Fax:757-941-0141
Practice Address - Street 1:115 NORGE LN
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-7230
Practice Address - Country:US
Practice Address - Phone:757-564-8627
Practice Address - Fax:757-941-0141
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202007162183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist