Provider Demographics
NPI:1467769174
Name:JAIN, PRINCE
Entity Type:Individual
Prefix:
First Name:PRINCE
Middle Name:
Last Name:JAIN
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 1:144 CHESTNUT CROSSING DR
Mailing Address - Street 2:APT E
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2643
Mailing Address - Country:US
Mailing Address - Phone:302-397-5858
Mailing Address - Fax:
Practice Address - Street 1:455 N 3RD ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:PA
Practice Address - Zip Code:19363-1430
Practice Address - Country:US
Practice Address - Phone:610-932-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442188183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist