MEDICARE: JONATHAN'S INVESTMENT INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PHY60761	OTHER	CA	BOP

General Provider Information

NPI Number	:	1750630273
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JONATHAN'S INVESTMENT INC

Provider Business Mailing Address
First Line	:	19341 BEAR VALLEY RD STE 103
Second Line	:
City	:	APPLE VALLEY
State	:	CA
Zip	:	92308-5152
Country	:	US
Telephone Number	:	760-983-2599
Fax Number	:	760-983-2662

Provider Business Practice Location Address
First Line	:	19341 BEAR VALLEY RD STE 103
Second Line	:
City	:	APPLE VALLEY
State	:	CA
Zip	:	92308-5152
Country	:	US
Telephone Number	:	760-983-2599
Fax Number	:	760-983-2662

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	VIRAJ PANKAJ PATEL
Credential	:	PHARM D
Telephone Number	:	760-983-2599

Provider Enumeration Date	:	08/29/2012
Last Update Date	:	11/04/2025

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