Provider Demographics
NPI:1043587934
Name:RAJU, VENKATA N (RPH)
Entity Type:Individual
Prefix:MR
First Name:VENKATA
Middle Name:N
Last Name:RAJU
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 1:550 GREGORY AVE
Mailing Address - Street 2:APT. B8
Mailing Address - City:WEEHAWKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07086-5798
Mailing Address - Country:US
Mailing Address - Phone:201-293-2259
Mailing Address - Fax:201-222-6852
Practice Address - Street 1:315 WILLOW AVE
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-7920
Practice Address - Country:US
Practice Address - Phone:201-222-6968
Practice Address - Fax:201-222-6852
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02134700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist