Provider Demographics
NPI:1497045702
Name:JAIN, KSHITIJ (BPHARM, MBA, MS)
Entity Type:Individual
Prefix:
First Name:KSHITIJ
Middle Name:
Last Name:JAIN
Suffix:
Gender:M
Credentials:BPHARM, MBA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17069 S DUPONT HWY
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19952-7403
Mailing Address - Country:US
Mailing Address - Phone:646-236-2619
Mailing Address - Fax:
Practice Address - Street 1:17069 S DUPONT HWY
Practice Address - Street 2:
Practice Address - City:HARRINGTON
Practice Address - State:DE
Practice Address - Zip Code:19952-7403
Practice Address - Country:US
Practice Address - Phone:646-236-2619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA10004127183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist