Provider Demographics
NPI:1598378861
Name:RAKHOLIA, NEIL B
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:B
Last Name:RAKHOLIA
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 1:2420 N BLACKSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-1747
Mailing Address - Country:US
Mailing Address - Phone:559-244-0974
Mailing Address - Fax:559-244-0980
Practice Address - Street 1:2420 N BLACKSTONE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-1747
Practice Address - Country:US
Practice Address - Phone:559-244-0974
Practice Address - Fax:559-244-0980
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH81436183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist