Provider Demographics
NPI:1114278082
Name:CALECA, JUSTEN ET (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JUSTEN
Middle Name:ET
Last Name:CALECA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1262 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-4036
Mailing Address - Country:US
Mailing Address - Phone:408-836-6312
Mailing Address - Fax:408-927-9308
Practice Address - Street 1:1262 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-4036
Practice Address - Country:US
Practice Address - Phone:408-836-6312
Practice Address - Fax:408-927-9308
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51718183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist