Provider Demographics
NPI:1740711852
Name:JEIRAN, KOOROSH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KOOROSH
Middle Name:
Last Name:JEIRAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 JAMERSON LN
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5680
Mailing Address - Country:US
Mailing Address - Phone:703-459-7394
Mailing Address - Fax:
Practice Address - Street 1:200 MEDICAL DR
Practice Address - Street 2:SUITE 289
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-1763
Practice Address - Country:US
Practice Address - Phone:757-750-1877
Practice Address - Fax:757-690-9040
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202209620183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist