Provider Demographics
NPI:1124295142
Name:CHVAT, JASON SCOTT (PHARMD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:SCOTT
Last Name:CHVAT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9503 LOS COCHES CT
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-6814
Mailing Address - Country:US
Mailing Address - Phone:951-834-5303
Mailing Address - Fax:951-943-4646
Practice Address - Street 1:75 W NUEVO RD
Practice Address - Street 2:SUITE H
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-0801
Practice Address - Country:US
Practice Address - Phone:951-322-4700
Practice Address - Fax:951-943-4645
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53345183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist