Provider Demographics
NPI:1497145510
Name:ALVINE, JACK (RPH)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:
Last Name:ALVINE
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 1:2928 RAMCO ST
Mailing Address - Street 2:#100
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-6406
Mailing Address - Country:US
Mailing Address - Phone:916-373-6398
Mailing Address - Fax:916-372-6226
Practice Address - Street 1:2928 RAMCO ST
Practice Address - Street 2:#100
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-6406
Practice Address - Country:US
Practice Address - Phone:916-373-6398
Practice Address - Fax:916-372-6226
Is Sole Proprietor?:No
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28279183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist