Provider Demographics
NPI:1174659619
Name:KANERIA, RAJ DUSHYANT
Entity Type:Individual
Prefix:MR
First Name:RAJ
Middle Name:DUSHYANT
Last Name:KANERIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RAJ
Other - Middle Name:DUSHYANT
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:47823 JAKE LN
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-5837
Mailing Address - Country:US
Mailing Address - Phone:734-983-0317
Mailing Address - Fax:734-663-0445
Practice Address - Street 1:1225 S LATSON RD STE 100
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-7658
Practice Address - Country:US
Practice Address - Phone:734-663-1362
Practice Address - Fax:734-663-0445
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031380183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist