Provider Demographics
NPI:1306353461
Name:ASTOR, JAY L (PHARMD)
Entity type:Individual
Prefix:MR
First Name:JAY
Middle Name:L
Last Name:ASTOR
Suffix:
Gender:M
Credentials:PHARMD
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34500 MONTEREY AVE
Mailing Address - Street 2:WALMART STORE 5096 ATTN: PHARMACY
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-2089
Mailing Address - Country:US
Mailing Address - Phone:760-328-3168
Mailing Address - Fax:760-328-5168
Practice Address - Street 1:34500 MONTEREY AVE
Practice Address - Street 2:WALMART STORE 5096 ATTN: PHARMACY
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-2089
Practice Address - Country:US
Practice Address - Phone:760-328-3168
Practice Address - Fax:760-328-5168
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA27239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist