Provider Demographics
NPI:1831794452
Name:AGEERU, JYOTHI
Entity type:Individual
Prefix:MS
First Name:JYOTHI
Middle Name:
Last Name:AGEERU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7859 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-5398
Mailing Address - Country:US
Mailing Address - Phone:703-256-6100
Mailing Address - Fax:703-256-8517
Practice Address - Street 1:7859 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-5398
Practice Address - Country:US
Practice Address - Phone:703-256-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202208155183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist