Provider Demographics
NPI:1407395866
Name:FAJARDO, JEFFREY LABANDELO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LABANDELO
Last Name:FAJARDO
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 1:12250 KNIGHTSBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-2521
Mailing Address - Country:US
Mailing Address - Phone:909-471-0637
Mailing Address - Fax:
Practice Address - Street 1:36450 INLAND VALLEY DR
Practice Address - Street 2:
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-9583
Practice Address - Country:US
Practice Address - Phone:951-600-3322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-18
Last Update Date:2017-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73176183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist