Provider Demographics
NPI:1922630813
Name:HOODA, JAIPAL (RPH)
Entity Type:Individual
Prefix:
First Name:JAIPAL
Middle Name:
Last Name:HOODA
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 1:132 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-6514
Mailing Address - Country:US
Mailing Address - Phone:616-396-2959
Mailing Address - Fax:616-396-3752
Practice Address - Street 1:132 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-6514
Practice Address - Country:US
Practice Address - Phone:616-396-2959
Practice Address - Fax:616-396-3752
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302036985183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302036985OtherPHARMACIST