Provider Demographics
NPI:1730697376
Name:MAH, JADINE C (PHARMD)
Entity type:Individual
Prefix:
First Name:JADINE
Middle Name:C
Last Name:MAH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 HEFFERNAN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231-4718
Mailing Address - Country:US
Mailing Address - Phone:760-357-9500
Mailing Address - Fax:760-357-3680
Practice Address - Street 1:420 HEFFERNAN AVE STE A
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-4718
Practice Address - Country:US
Practice Address - Phone:760-357-9500
Practice Address - Fax:760-357-3680
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-17
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45475333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy