Provider Demographics
NPI:1003488701
Name:JAIN, KAJAL
Entity Type:Individual
Prefix:
First Name:KAJAL
Middle Name:
Last Name:JAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 20TH AVE N STE 601
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-5601
Mailing Address - Country:US
Mailing Address - Phone:615-284-5185
Mailing Address - Fax:
Practice Address - Street 1:300 20TH AVE N STE 601
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-5601
Practice Address - Country:US
Practice Address - Phone:615-284-5185
Practice Address - Fax:615-565-6748
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN451761835P2201X
FLPS607951835P2201X
GARPH0313891835P2201X
IN26028149A1835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care