Provider Demographics
NPI:1669518155
Name:JINKINS, SHASTA STYLES (BS PHARMACY)
Entity type:Individual
Prefix:MRS
First Name:SHASTA
Middle Name:STYLES
Last Name:JINKINS
Suffix:
Gender:F
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16317 OLD RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VA
Mailing Address - Zip Code:23192-2229
Mailing Address - Country:US
Mailing Address - Phone:804-883-7082
Mailing Address - Fax:
Practice Address - Street 1:16317 OLD RIDGE RD
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VA
Practice Address - Zip Code:23192-2229
Practice Address - Country:US
Practice Address - Phone:804-883-7082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202009539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist