Provider Demographics
NPI:1063827764
Name:RAJI, LATEEF
Entity Type:Individual
Prefix:
First Name:LATEEF
Middle Name:
Last Name:RAJI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5910 GREENBELT RD
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-1010
Mailing Address - Country:US
Mailing Address - Phone:301-441-8810
Mailing Address - Fax:301-441-8784
Practice Address - Street 1:5910 GREENBELT RD
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-1010
Practice Address - Country:US
Practice Address - Phone:301-441-8810
Practice Address - Fax:301-441-8784
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19887183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist