Provider Demographics
NPI:1013255272
Name:JOSEPH, REJI (RPH)
Entity Type:Individual
Prefix:MR
First Name:REJI
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 SW 104TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-4718
Mailing Address - Country:US
Mailing Address - Phone:954-662-1989
Mailing Address - Fax:
Practice Address - Street 1:19441 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33332-1653
Practice Address - Country:US
Practice Address - Phone:954-434-5930
Practice Address - Fax:954-434-3741
Is Sole Proprietor?:No
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34789183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist