Provider Demographics
NPI:1679178115
Name:JEFFER, JEANNE LYNN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:LYNN
Last Name:JEFFER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2148 E MIDLAND TRL
Mailing Address - Street 2:
Mailing Address - City:BUENA VISTA
Mailing Address - State:VA
Mailing Address - Zip Code:24416-4603
Mailing Address - Country:US
Mailing Address - Phone:540-261-2164
Mailing Address - Fax:540-261-1360
Practice Address - Street 1:2148 E MIDLAND TRL
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:VA
Practice Address - Zip Code:24416-4603
Practice Address - Country:US
Practice Address - Phone:540-261-2164
Practice Address - Fax:540-261-1360
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202009089183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist