Provider Demographics
NPI:1164869426
Name:JAISWAL, REETESH KUMAR (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:REETESH
Middle Name:KUMAR
Last Name:JAISWAL
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5214 NEIL DR
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33714-2401
Mailing Address - Country:US
Mailing Address - Phone:727-528-1072
Mailing Address - Fax:
Practice Address - Street 1:5214 NEIL DR
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33714-2401
Practice Address - Country:US
Practice Address - Phone:727-528-1072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS393731835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric