Provider Demographics
NPI:1861808875
Name:RADFORD, JAMISON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JAMISON
Middle Name:
Last Name:RADFORD
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 1:11 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153
Mailing Address - Country:US
Mailing Address - Phone:540-387-4567
Mailing Address - Fax:540-387-2196
Practice Address - Street 1:11 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153
Practice Address - Country:US
Practice Address - Phone:540-387-4567
Practice Address - Fax:540-387-2196
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0008539183500000X
VA0202213399183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist