Provider Demographics
NPI:1225365729
Name:DEORA, JITENDRA M
Entity Type:Individual
Prefix:MR
First Name:JITENDRA
Middle Name:M
Last Name:DEORA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 N COLLINS ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-6134
Mailing Address - Country:US
Mailing Address - Phone:817-303-3275
Mailing Address - Fax:817-303-3816
Practice Address - Street 1:1020 N COLLINS ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-6134
Practice Address - Country:US
Practice Address - Phone:817-303-3275
Practice Address - Fax:817-303-3816
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35174183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist