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General NPI Number Information
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NPI Number | 1215350327
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Entity Type | Organization
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Legal Business Name | JEEVA LLC
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Dates
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Enumeration Date | 01/24/2014
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Last Update Date | 10/23/2015
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Provider Practice Location Address
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Address Line | 501 W GLENOAKS BLVD STE 12
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City | GLENDALE
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State | CA
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Zip | 91202-4041
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Country | US
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Telephone | 818-500-1517
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Fax | 818-500-1519
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Provider Business Mailing Address
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Address Line | 501 W GLENOAKS BLVD SUITE#12
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City | GLENDALE
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State | CA
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Zip | 91202-2896
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Country | US
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Telephone | 818-500-1517
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Fax | 818-500-1519
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Authorized Official
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Title or Position | MANAGER
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Name | MR. AVINASH GOVIND GHANEKAR
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Credential | RPH
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Telephone | 818-500-2517
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHY51730
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License Number State | CA
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