Healthcare Provider Details

I. General information

NPI: 1942874870
Provider Name (Legal Business Name): GIRIRAJ CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2021
Last Update Date: 05/15/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24825 ALESSANDRO BLVD STE 2
MORENO VALLEY CA
92553-5851
US

IV. Provider business mailing address

24825 ALESSANDRO BLVD STE 2
MORENO VALLEY CA
92553-5851
US

V. Phone/Fax

Practice location:
  • Phone: 951-243-2530
  • Fax: 951-243-2554
Mailing address:
  • Phone: 951-243-2530
  • Fax: 951-243-2554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHIRAG RAKHOLIA
Title or Position: PRESIDENT
Credential:
Phone: 951-243-2530