Healthcare Provider Details

I. General information

NPI: 1467743955
Provider Name (Legal Business Name): KAMLESH JAIN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2011
Last Update Date: 05/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 E TULARE AVE
TULARE CA
93274-3155
US

IV. Provider business mailing address

KUSM-KUNJ,MANGILAL PLOTS, CAMP,
AMRAVATI MAHARASTRA
444910
IN

V. Phone/Fax

Practice location:
  • Phone: 559-688-5839
  • Fax: 559-686-2471
Mailing address:
  • Phone: 721-266-3015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH 59685
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: