Provider Demographics
NPI:1831785138
Name:NAIR, JEEVA VIJAY
Entity type:Individual
Prefix:
First Name:JEEVA
Middle Name:VIJAY
Last Name:NAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9428 STEELE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-3299
Mailing Address - Country:US
Mailing Address - Phone:980-233-9960
Mailing Address - Fax:980-233-9961
Practice Address - Street 1:4701 SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-2117
Practice Address - Country:US
Practice Address - Phone:704-523-3227
Practice Address - Fax:704-523-8468
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30143183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist