Provider Demographics
NPI:1528395530
Name:CHAUDHARY, JITENDRA BHALENDRABHAI (RPH)
Entity Type:Individual
Prefix:MR
First Name:JITENDRA
Middle Name:BHALENDRABHAI
Last Name:CHAUDHARY
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 1:2716 SW MILITARY DR STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78224-1009
Mailing Address - Country:US
Mailing Address - Phone:210-927-3742
Mailing Address - Fax:210-927-3752
Practice Address - Street 1:2716 SW MILITARY DR STE 102
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1009
Practice Address - Country:US
Practice Address - Phone:210-927-3742
Practice Address - Fax:210-927-3752
Is Sole Proprietor?:No
Enumeration Date:2009-11-11
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44855183500000X
FLPS40358183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist