Healthcare Provider Details

I. General information

NPI: 1164084646
Provider Name (Legal Business Name): JECEDTHEL DUMPIT PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2019
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1993 MCKEE RD
SAN JOSE CA
95116-1406
US

IV. Provider business mailing address

751 S BASCOM AVE BLDG W
SAN JOSE CA
95128-2604
US

V. Phone/Fax

Practice location:
  • Phone: 408-254-6388
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number76851
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: