Provider Demographics
NPI:1568503134
Name:NEGRETE, JIMMY RAY (RPH)
Entity Type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:RAY
Last Name:NEGRETE
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 1:5582 KERN DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-4531
Mailing Address - Country:US
Mailing Address - Phone:714-846-3854
Mailing Address - Fax:714-846-3854
Practice Address - Street 1:18525 YORBA LINDA BLVD
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-4135
Practice Address - Country:US
Practice Address - Phone:714-777-2737
Practice Address - Fax:714-777-9252
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH38356183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH38356OtherSTATE LICENSE