Provider Demographics
NPI:1679210181
Name:NEIGHBORCARE, PLLC
Entity type:Organization
Organization Name:NEIGHBORCARE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITONER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:ITSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:MSN, AGACNP-BC
Authorized Official - Phone:540-330-4455
Mailing Address - Street 1:3133 YARDLEY DR NW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-2309
Mailing Address - Country:US
Mailing Address - Phone:540-330-4455
Mailing Address - Fax:
Practice Address - Street 1:3133 YARDLEY DR NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-2309
Practice Address - Country:US
Practice Address - Phone:540-330-4455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-16
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care