Provider Demographics
NPI:1629354030
Name:SAKHIYA, JITENDRA DHIRAJLAL
Entity Type:Individual
Prefix:
First Name:JITENDRA
Middle Name:DHIRAJLAL
Last Name:SAKHIYA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 HUEMMER TER
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3330
Mailing Address - Country:US
Mailing Address - Phone:973-779-3625
Mailing Address - Fax:
Practice Address - Street 1:46 HUEMMER TER
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3330
Practice Address - Country:US
Practice Address - Phone:973-779-3625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-30
Last Update Date:2011-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03467600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist