Provider Demographics
NPI:1801569397
Name:PATEL, JAIMIN NAREN (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:JAIMIN
Middle Name:NAREN
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 HYDE PARK CT
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-6620
Mailing Address - Country:US
Mailing Address - Phone:951-588-4894
Mailing Address - Fax:
Practice Address - Street 1:12401 HESPERIA RD STE 3
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5844
Practice Address - Country:US
Practice Address - Phone:760-552-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83692183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist