Provider Demographics
NPI:1356643878
Name:WEST, JOHN CHRISTOPHER (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CHRISTOPHER
Last Name:WEST
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:CHRISTOPHER
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11120 S LAKES DR
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-4327
Mailing Address - Country:US
Mailing Address - Phone:703-620-2444
Mailing Address - Fax:703-758-1578
Practice Address - Street 1:11120 S LAKES DR
Practice Address - Street 2:SAFEWAY
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-4327
Practice Address - Country:US
Practice Address - Phone:703-620-2444
Practice Address - Fax:703-758-1578
Is Sole Proprietor?:No
Enumeration Date:2010-12-04
Last Update Date:2010-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202010244183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist