Active NPI
Jaen Sidhom
- Pharmacist
- Centreville, VA
National Provider Identifier
1891288593
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 0202207584
- Practice address
- 13933 Middle Creek PL
Centreville, VA 20121-3553 - Phone
- (201) 892-9548
- NPI assigned
- Jun 7, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0202207584 | VA | Primary |
Addresses
Primary practice location
13933 Middle Creek PL
Centreville, VA 20121-3553
Mailing address
13933 Middle Creek PL
Centreville, VA 20121-3553
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0202207584 | VA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Archangel Michael LLC | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Rockville, MD
- NPI 1326756057
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1668038400000",
"number": "1891288593",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13933 MIDDLE CREEK PL",
"city": "CENTREVILLE",
"state": "VA",
"postal_code": "201213553"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13933 MIDDLE CREEK PL",
"city": "CENTREVILLE",
"state": "VA",
"postal_code": "201213553",
"telephone_number": "201-892-9548"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIDHOM",
"first_name": "JAEN",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-06-07",
"last_updated": "2022-11-10",
"certification_date": "2022-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "VA",
"license": "0202207584",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Centreville, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.