Healthcare Provider Details

I. General information

NPI: 1407395866
Provider Name (Legal Business Name): JEFFREY LABANDELO FAJARDO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2017
Last Update Date: 02/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36450 INLAND VALLEY DR
WILDOMAR CA
92595-9583
US

IV. Provider business mailing address

12250 KNIGHTSBRIDGE DR
RANCHO CUCAMONGA CA
91739-2521
US

V. Phone/Fax

Practice location:
  • Phone: 951-600-3322
  • Fax:
Mailing address:
  • Phone: 909-471-0637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number73176
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: