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General NPI Number Information
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NPI Number | 1306516042
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Entity Type | Individual
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Provider Name | JAKE R HOCTOR PHARMD
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Gender | Male
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Dates
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Enumeration Date | 09/15/2021
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Last Update Date | 09/15/2021
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Provider Practice Location Address
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Address Line | 26973 NEWPORT RD
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City | MENIFEE
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State | CA
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Zip | 92584-9221
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Country | US
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Telephone | 951-301-6356
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Fax |
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Provider Business Mailing Address
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Address Line | 23964 PEPPERLEAF ST
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City | MURRIETA
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State | CA
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Zip | 92562-3296
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Country | US
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Telephone | 951-595-5877
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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 | 85103
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License Number State | CA
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