Provider Demographics
NPI:1952531089
Name:PADRE, JEANELLE MARIE V (PHARMD)
Entity Type:Individual
Prefix:
First Name:JEANELLE
Middle Name:MARIE V
Last Name:PADRE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13337 SOUTH ST
Mailing Address - Street 2:#277
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-7308
Mailing Address - Country:US
Mailing Address - Phone:562-282-0123
Mailing Address - Fax:562-467-1686
Practice Address - Street 1:13337 SOUTH ST
Practice Address - Street 2:#277
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-7308
Practice Address - Country:US
Practice Address - Phone:562-282-0123
Practice Address - Fax:562-467-1686
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61483183500000X, 1835G0303X, 1835P0018X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy