Provider Demographics
NPI:1215235395
Name:ALSTON, JEFFREY WATSON (RPH)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:WATSON
Last Name:ALSTON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 TERRYS RUN
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-2546
Mailing Address - Country:US
Mailing Address - Phone:757-897-2842
Mailing Address - Fax:
Practice Address - Street 1:421 WYTHE CREEK RD
Practice Address - Street 2:
Practice Address - City:POQUOSON
Practice Address - State:VA
Practice Address - Zip Code:23662
Practice Address - Country:US
Practice Address - Phone:757-868-0297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011347183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist