Provider Demographics
NPI:1114528932
Name:RAJ, JAIVEERSINH MAHENDRASINH (PHARMD)
Entity Type:Individual
Prefix:
First Name:JAIVEERSINH
Middle Name:MAHENDRASINH
Last Name:RAJ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N YORK RD
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-2621
Mailing Address - Country:US
Mailing Address - Phone:215-784-1964
Mailing Address - Fax:215-784-1967
Practice Address - Street 1:315 N YORK RD
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-2621
Practice Address - Country:US
Practice Address - Phone:215-784-1964
Practice Address - Fax:215-784-1967
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP449778183500000X
NJ28RI04022200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist