Provider Demographics
NPI:1184919888
Name:LAL, JITENDRA CHAND
Entity type:Individual
Prefix:DR
First Name:JITENDRA
Middle Name:CHAND
Last Name:LAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 SNYDER AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-9358
Mailing Address - Country:US
Mailing Address - Phone:209-996-5206
Mailing Address - Fax:
Practice Address - Street 1:3900 SISK RD
Practice Address - Street 2:T0938
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-3215
Practice Address - Country:US
Practice Address - Phone:209-545-3325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 58459183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist