=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124295142
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASON SCOTT CHVAT PHARM.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2008
-----------------------------------------------------
Last Update Date | 05/24/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 75 W NUEVO RD SUITE H
-----------------------------------------------------
City | PERRIS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92571-0801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-322-4700
-----------------------------------------------------
Fax | 951-943-4645
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9503 LOS COCHES CT
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92508-6814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-834-5303
-----------------------------------------------------
Fax | 951-943-4646
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 53345
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------