Provider Demographics
NPI:1578273256
Name:MAHONEY, JASMIN (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:JASMIN
Middle Name:
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:JASMIN
Other - Middle Name:
Other - Last Name:DAILISAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:1122 N JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-5076
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1122 N JOHNSON ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-5076
Practice Address - Country:US
Practice Address - Phone:571-235-1492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X
VA0202207643183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No171400000XOther Service ProvidersHealth & Wellness Coach