Provider Demographics
NPI:1922284249
Name:RAJ MISTRY
Entity Type:Organization
Organization Name:RAJ MISTRY
Other - Org Name:COURTESY DRUGS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:MISTRY
Authorized Official - Suffix:
Authorized Official - Credentials:B PHARM
Authorized Official - Phone:323-583-4307
Mailing Address - Street 1:3180 E FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-5830
Mailing Address - Country:US
Mailing Address - Phone:323-583-4307
Mailing Address - Fax:323-583-0900
Practice Address - Street 1:3180 E FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-5830
Practice Address - Country:US
Practice Address - Phone:323-583-4307
Practice Address - Fax:323-583-0900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY34424333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA344240Medicaid