Provider Demographics
NPI:1336977487
Name:CERVANTES, JOSHUA ANDRE JARLEGO (RPH)
Entity type:Individual
Prefix:
First Name:JOSHUA ANDRE
Middle Name:JARLEGO
Last Name:CERVANTES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8760 CENTER PKWY APT 237
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-8444
Mailing Address - Country:US
Mailing Address - Phone:916-512-7694
Mailing Address - Fax:
Practice Address - Street 1:8300 VALDEZ AVE BLDG 5
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828-0938
Practice Address - Country:US
Practice Address - Phone:916-379-1606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89494183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist