Provider Demographics
NPI:1134568603
Name:AL FRAIJAT, RAZAN
Entity type:Individual
Prefix:
First Name:RAZAN
Middle Name:
Last Name:AL FRAIJAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10048 MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90604-1201
Mailing Address - Country:US
Mailing Address - Phone:562-903-9678
Mailing Address - Fax:
Practice Address - Street 1:10048 MILLS AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90604-1201
Practice Address - Country:US
Practice Address - Phone:562-903-9678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2283232183500000X
CA72836183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist