Provider Demographics
NPI:1942831664
Name:RAVAL, JIMESH J (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JIMESH
Middle Name:J
Last Name:RAVAL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35616 EASTMONT DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-3539
Mailing Address - Country:US
Mailing Address - Phone:586-935-8779
Mailing Address - Fax:
Practice Address - Street 1:15121 24 MILE RD
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315-2109
Practice Address - Country:US
Practice Address - Phone:586-677-4015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302041813183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist