Provider Demographics
NPI:1770168676
Name:SALFITI, RAJA
Entity type:Individual
Prefix:
First Name:RAJA
Middle Name:
Last Name:SALFITI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 W EAGLE DR STE C
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-3721
Mailing Address - Country:US
Mailing Address - Phone:817-532-6112
Mailing Address - Fax:
Practice Address - Street 1:1101 W EAGLE DR STE C
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3721
Practice Address - Country:US
Practice Address - Phone:817-532-6112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45109183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist