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General NPI Number Information
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NPI Number | 1013936350
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Entity Type | Individual
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Provider Name | RANDY DUANE JAYNE R.PH.
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Gender | Male
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1035 W RAMSEY ST STE B3
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City | BANNING
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State | CA
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Zip | 92220-4400
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Country | US
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Telephone | 951-849-4920
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Fax |
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Provider Business Mailing Address
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Address Line | 22124 DROVER WAY
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City | CANYON LAKE
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State | CA
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Zip | 92587-7608
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Country | US
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Telephone | 951-244-6886
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH38586
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License Number State | CA
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