Provider Demographics
NPI:1942476411
Name:LEEHOFFMAN, JACQUELINE DAWN (PD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:DAWN
Last Name:LEEHOFFMAN
Suffix:
Gender:F
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8627 BROOK RD
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-1504
Mailing Address - Country:US
Mailing Address - Phone:703-635-6520
Mailing Address - Fax:
Practice Address - Street 1:8627 BROOK RD
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-1504
Practice Address - Country:US
Practice Address - Phone:703-635-6520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202009809183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist