Provider Demographics
NPI:1073186862
Name:RATHORE, RAGHAVENDRA SINGH
Entity Type:Individual
Prefix:DR
First Name:RAGHAVENDRA
Middle Name:SINGH
Last Name:RATHORE
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 1:525 SELLERS PL
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-5315
Mailing Address - Country:US
Mailing Address - Phone:619-306-7212
Mailing Address - Fax:
Practice Address - Street 1:100 W RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344-5205
Practice Address - Country:US
Practice Address - Phone:928-669-2141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS025238183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist