MEDICARE: RAJ RAKHOLIA PHARMD

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	87642	CA

General Provider Information

NPI Number	:	1538942651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAJ RAKHOLIA PHARMD

Provider Business Mailing Address
First Line	:	427 N BETH ST UNIT B
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92806-3334
Country	:	US
Telephone Number	:	714-595-1405
Fax Number	:

Provider Business Practice Location Address
First Line	:	1222 W 5TH ST
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92411-2739
Country	:	US
Telephone Number	:	909-884-0128
Fax Number	:	909-381-8326

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

Provider Enumeration Date	:	08/14/2023
Last Update Date	:	08/14/2023

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