Provider Demographics
NPI:1811579352
Name:RAVAL, DHRUTI (RAH)
Entity Type:Individual
Prefix:
First Name:DHRUTI
Middle Name:
Last Name:RAVAL
Suffix:
Gender:F
Credentials:RAH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HUNTER ST
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-2951
Mailing Address - Country:US
Mailing Address - Phone:504-715-5396
Mailing Address - Fax:
Practice Address - Street 1:890 SAINT GEORGES AVE
Practice Address - Street 2:
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-2659
Practice Address - Country:US
Practice Address - Phone:732-396-1990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-24
Last Update Date:2021-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03326300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist