Provider Demographics
NPI:1346572567
Name:WARDE, RAJENDRA P (RPH)
Entity Type:Individual
Prefix:MR
First Name:RAJENDRA
Middle Name:P
Last Name:WARDE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6384 GREENLAND CHASE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-9437
Mailing Address - Country:US
Mailing Address - Phone:904-962-4721
Mailing Address - Fax:
Practice Address - Street 1:3604 UNIVERSITY BLVD S
Practice Address - Street 2:SUITE 102
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4241
Practice Address - Country:US
Practice Address - Phone:904-813-7634
Practice Address - Fax:904-551-6555
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS29953183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist