Provider Demographics
NPI:1447559307
Name:JANA, RIA
Entity Type:Individual
Prefix:MRS
First Name:RIA
Middle Name:
Last Name:JANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 SERENA AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-7567
Mailing Address - Country:US
Mailing Address - Phone:559-801-3916
Mailing Address - Fax:
Practice Address - Street 1:1210 N BLACKSTONE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-3606
Practice Address - Country:US
Practice Address - Phone:559-445-0694
Practice Address - Fax:559-445-1480
Is Sole Proprietor?:No
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61258183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist