MEDICARE: MR. RAJ MISTRY RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH38454	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RPH 38454	OTHER	CA	PHARMACIST
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316937675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAJ MISTRY RPH

Provider Business Mailing Address
First Line	:	3180 E FLORENCE AVE
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-5830
Country	:	US
Telephone Number	:	323-583-4307
Fax Number	:	323-583-0900

Provider Business Practice Location Address
First Line	:	3180 E FLORENCE AVE
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-5830
Country	:	US
Telephone Number	:	323-583-4307
Fax Number	:	323-583-0900

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	02/07/2008

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