Provider Demographics
NPI:1114434651
Name:DHIRAJ LLC
Entity Type:Organization
Organization Name:DHIRAJ LLC
Other - Org Name:BUCKHEAD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHETANKUMAR
Authorized Official - Middle Name:M
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-456-5450
Mailing Address - Street 1:730 SOM CENTER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2364
Mailing Address - Country:US
Mailing Address - Phone:440-605-0303
Mailing Address - Fax:440-605-1437
Practice Address - Street 1:730 SOM CENTER RD STE 100
Practice Address - Street 2:
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-2364
Practice Address - Country:US
Practice Address - Phone:440-605-0303
Practice Address - Fax:440-605-1437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-05
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPMY.022847400-033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy