Provider Demographics
NPI:1366918187
Name:FELIPE, JERALD VINCENT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JERALD
Middle Name:VINCENT
Last Name:FELIPE
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 1:3400 STEVENSON BLVD APT V37
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-5854
Mailing Address - Country:US
Mailing Address - Phone:818-703-2994
Mailing Address - Fax:
Practice Address - Street 1:320 LENNON LN
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2419
Practice Address - Country:US
Practice Address - Phone:925-906-4800
Practice Address - Fax:925-906-4805
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA797221835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care