Healthcare Provider Details

I. General information

NPI: 1831343532
Provider Name (Legal Business Name): JWALANT SHUKLA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 CONTINENTAL CIR # 1437
MOUNTAIN VIEW CA
94040-3366
US

IV. Provider business mailing address

210 VISTA COVE CIR
SACRAMENTO CA
95835-2002
US

V. Phone/Fax

Practice location:
  • Phone: 650-966-1910
  • Fax:
Mailing address:
  • Phone: 916-285-0470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number55609
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: