Provider Demographics
NPI:1073985487
Name:RAJYAGURU, JIMIT Y
Entity Type:Individual
Prefix:
First Name:JIMIT
Middle Name:Y
Last Name:RAJYAGURU
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 1:1819 MARLTON PIKE W
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-3206
Mailing Address - Country:US
Mailing Address - Phone:856-662-3685
Mailing Address - Fax:
Practice Address - Street 1:1819 MARLTON PIKE W
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-3206
Practice Address - Country:US
Practice Address - Phone:856-662-3685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-25
Last Update Date:2015-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03742700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist