Provider Demographics
NPI:1942917158
Name:VAHORA, RAISH AHEMAD NAJIRBHAI (PHARMD)
Entity Type:Individual
Prefix:
First Name:RAISH AHEMAD
Middle Name:NAJIRBHAI
Last Name:VAHORA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W 144TH ST
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60827-2733
Mailing Address - Country:US
Mailing Address - Phone:708-849-5512
Mailing Address - Fax:708-849-6872
Practice Address - Street 1:250 W 144TH ST
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:IL
Practice Address - Zip Code:60827-2733
Practice Address - Country:US
Practice Address - Phone:708-849-5512
Practice Address - Fax:708-849-6872
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051305084183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist