Provider Demographics
NPI:1750801080
Name:CHODROW, JEFFERY ALAN
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:ALAN
Last Name:CHODROW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1282 TWELVE ACRE RD
Mailing Address - Street 2:
Mailing Address - City:MONETA
Mailing Address - State:VA
Mailing Address - Zip Code:24121-1779
Mailing Address - Country:US
Mailing Address - Phone:540-330-5252
Mailing Address - Fax:
Practice Address - Street 1:1282 TWELVE ACRE RD
Practice Address - Street 2:
Practice Address - City:MONETA
Practice Address - State:VA
Practice Address - Zip Code:24121-1779
Practice Address - Country:US
Practice Address - Phone:540-330-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02022074821835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric