Healthcare Provider Details

I. General information

NPI: 1295089175
Provider Name (Legal Business Name): SRI RAJ INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2012
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3409 CALLOWAY DR UNIT 602
BAKERSFIELD CA
93312-2534
US

IV. Provider business mailing address

3409 CALLOWAY DR UNIT 602
BAKERSFIELD CA
93312-2534
US

V. Phone/Fax

Practice location:
  • Phone: 661-589-7979
  • Fax: 661-589-7222
Mailing address:
  • Phone: 661-589-7979
  • Fax: 661-589-7222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY 51086
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY 51086
License Number StateCA

VIII. Authorized Official

Name: MISS DEEPA B KAPADIA
Title or Position: PHARMACIST/PHARMACY MANAGER
Credential: R.PH
Phone: 661-589-7979