Provider Demographics
NPI:1376136275
Name:JACKOP ESHAK, JOHN ARIMON (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN ARIMON
Middle Name:
Last Name:JACKOP ESHAK
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 1:515 HAYES CIR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-1160
Mailing Address - Country:US
Mailing Address - Phone:951-768-2437
Mailing Address - Fax:
Practice Address - Street 1:9194 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3872
Practice Address - Country:US
Practice Address - Phone:951-977-8667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82763183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist