Provider Demographics
NPI:1194815803
Name:JAINULABUDEEN, JALAL (RPH)
Entity Type:Individual
Prefix:MR
First Name:JALAL
Middle Name:
Last Name:JAINULABUDEEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 ELIOT DR
Mailing Address - Street 2:
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-2420
Mailing Address - Country:US
Mailing Address - Phone:518-439-8219
Mailing Address - Fax:
Practice Address - Street 1:19 ELIOT DR
Practice Address - Street 2:
Practice Address - City:SLINGERLANDS
Practice Address - State:NY
Practice Address - Zip Code:12159-2420
Practice Address - Country:US
Practice Address - Phone:518-439-8219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033361183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY033361OtherREGISTERED PHARMACIST