Provider Demographics
NPI:1477730562
Name:JANI, BHAIRAVI DEEPAK (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:BHAIRAVI
Middle Name:DEEPAK
Last Name:JANI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:BHAIRAVI
Other - Middle Name:SAMEER
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5580 PATRICIA WAY
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-5627
Mailing Address - Country:US
Mailing Address - Phone:714-694-0674
Mailing Address - Fax:
Practice Address - Street 1:5580 PATRICIA WAY
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92887-5627
Practice Address - Country:US
Practice Address - Phone:714-694-0674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist