Provider Demographics
NPI:1073802328
Name:MAHARAJ, ROSHENLALL (BPHARM)
Entity Type:Individual
Prefix:MR
First Name:ROSHENLALL
Middle Name:
Last Name:MAHARAJ
Suffix:
Gender:M
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 LAS GAVIOTAS BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-8065
Mailing Address - Country:US
Mailing Address - Phone:757-214-9245
Mailing Address - Fax:
Practice Address - Street 1:975 HODGES FERRY RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-1343
Practice Address - Country:US
Practice Address - Phone:757-465-0063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202210229183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist