Provider Demographics
NPI:1972725307
Name:RAI, JAGWANT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JAGWANT
Middle Name:
Last Name:RAI
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 1:13821 DURANGO DR
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3115
Mailing Address - Country:US
Mailing Address - Phone:858-259-4852
Mailing Address - Fax:
Practice Address - Street 1:9350 CAMPUS POINT DRIVE
Practice Address - Street 2:PERLMAN AMBULATORY CARE PHARMACY
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-7729
Practice Address - Country:US
Practice Address - Phone:858-657-8610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45054183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist