Provider Demographics
NPI:1881459394
Name:KANCHANWALA, VRAJESH RAJESH
Entity type:Individual
Prefix:
First Name:VRAJESH
Middle Name:RAJESH
Last Name:KANCHANWALA
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 1:6600 PLUM CREEK DR APT 254
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-1632
Mailing Address - Country:US
Mailing Address - Phone:171-349-9970
Mailing Address - Fax:
Practice Address - Street 1:2931 CENTRAL CITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77551-1129
Practice Address - Country:US
Practice Address - Phone:409-740-2488
Practice Address - Fax:409-740-8320
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2025-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73663183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist