Provider Demographics
NPI:1467743955
Name:JAIN, KAMLESH (RPH)
Entity Type:Individual
Prefix:MISS
First Name:KAMLESH
Middle Name:
Last Name:JAIN
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:KUSM-KUNJ,MANGILAL PLOTS,
Mailing Address - Street 2:CAMP,
Mailing Address - City:AMRAVATI
Mailing Address - State:MAHARASTRA
Mailing Address - Zip Code:444910
Mailing Address - Country:IN
Mailing Address - Phone:721-266-3015
Mailing Address - Fax:
Practice Address - Street 1:1645 E TULARE AVE
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-3155
Practice Address - Country:US
Practice Address - Phone:559-688-5839
Practice Address - Fax:559-686-2471
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 59685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist