Provider Demographics
NPI:1326379611
Name:MUKUNDAN, JINESH
Entity type:Individual
Prefix:
First Name:JINESH
Middle Name:
Last Name:MUKUNDAN
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 1:501 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-5286
Mailing Address - Country:US
Mailing Address - Phone:302-225-6888
Mailing Address - Fax:
Practice Address - Street 1:501 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-5286
Practice Address - Country:US
Practice Address - Phone:302-225-6888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0003869183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEA1-0003869OtherDE PHARMACIST LICENSE NUMBER