Provider Demographics
NPI:1568451771
Name:JINA, PREMESH (RPH)
Entity Type:Individual
Prefix:MR
First Name:PREMESH
Middle Name:
Last Name:JINA
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 1:54 JUNEBERRY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-4503
Mailing Address - Country:US
Mailing Address - Phone:844-458-6224
Mailing Address - Fax:
Practice Address - Street 1:510 W CENTRAL AVE STE A
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3032
Practice Address - Country:US
Practice Address - Phone:844-458-6224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47066183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist