Provider Demographics
NPI:1801491741
Name:JIVA, KAVIR (RPH)
Entity type:Individual
Prefix:
First Name:KAVIR
Middle Name:
Last Name:JIVA
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 1:2207 HIGHWAY 35 N STE A
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382-3340
Mailing Address - Country:US
Mailing Address - Phone:361-729-5545
Mailing Address - Fax:
Practice Address - Street 1:2207 HIGHWAY 35 N STE A
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:TX
Practice Address - Zip Code:78382-3340
Practice Address - Country:US
Practice Address - Phone:361-729-5545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57665183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist