Basic Information
| Provider Information | |||||||||
| NPI: | 1639412737 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TSAI | ||||||||
| FirstName: | JERRY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5702 LOFTHILL CT | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223031058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087208060 | ||||||||
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| Practice Location | |||||||||
| Address1: | 700 2ND ST NE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200028100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2023463000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2013 | ||||||||
| LastUpdateDate: | 03/27/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PH100000920 | DC | Y | Pharmacy Service Providers | Pharmacist | 183500000X | 20011 | MD | N | Pharmacy Service Providers | Pharmacist | 183500000X | 28RI03386100 | NJ | N | Pharmacy Service Providers | Pharmacist | 183500000X | 0202210362 | VA | N | Pharmacy Service Providers | Pharmacist |
No ID Information.