Provider Demographics
NPI:1609246727
Name:PRAJAL RX LLC
Entity Type:Organization
Organization Name:PRAJAL RX LLC
Other - Org Name:PHARMACY OF HATBORO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DHRUPAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-443-9999
Mailing Address - Street 1:420 S YORK RD STE D
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-3970
Mailing Address - Country:US
Mailing Address - Phone:215-443-9999
Mailing Address - Fax:215-442-9999
Practice Address - Street 1:420 S YORK RD STE D
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040-3970
Practice Address - Country:US
Practice Address - Phone:215-443-9999
Practice Address - Fax:215-442-9999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4826043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA104007639-0001Medicaid
2155910OtherPK