Provider Demographics
NPI:1336359215
Name:AGARWAL, JAYKUMAR A (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAYKUMAR
Middle Name:A
Last Name:AGARWAL
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 1:716 WILLOW BROOK RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3563
Mailing Address - Country:US
Mailing Address - Phone:718-440-5313
Mailing Address - Fax:
Practice Address - Street 1:833 BATTLEFIELD BLVD N
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4871
Practice Address - Country:US
Practice Address - Phone:757-382-9717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206806183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202206806OtherPHARMACIST LICENSE NUMBER