Provider Demographics
NPI:1104279009
Name:JOHAL, JASKARN
Entity type:Individual
Prefix:
First Name:JASKARN
Middle Name:
Last Name:JOHAL
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 1:3705 LIBBY LN
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-9120
Mailing Address - Country:US
Mailing Address - Phone:530-218-1545
Mailing Address - Fax:530-846-0729
Practice Address - Street 1:1583 HIGHWAY 99
Practice Address - Street 2:
Practice Address - City:GRIDLEY
Practice Address - State:CA
Practice Address - Zip Code:95948-3107
Practice Address - Country:US
Practice Address - Phone:530-846-3334
Practice Address - Fax:530-846-0729
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69471183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist