Healthcare Provider Details

I. General information

NPI: 1841573060
Provider Name (Legal Business Name): RAJENDRA DHOTE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 NW 57TH AVE
MIAMI FL
33126-4814
US

IV. Provider business mailing address

655 NW 57TH AVE
MIAMI FL
33126-4814
US

V. Phone/Fax

Practice location:
  • Phone: 786-388-1466
  • Fax: 786-388-9209
Mailing address:
  • Phone: 786-388-1466
  • Fax: 786-388-9209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS040810
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: