Healthcare Provider Details

I. General information

NPI: 1912227398
Provider Name (Legal Business Name): URJA PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 S MAIN ST
WILLISTON FL
32696-2657
US

IV. Provider business mailing address

219 S MAIN ST
WILLISTON FL
32696-2657
US

V. Phone/Fax

Practice location:
  • Phone: 352-529-6966
  • Fax: 352-529-6968
Mailing address:
  • Phone: 352-529-6966
  • Fax: 352-529-6968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH24667
License Number StateFL

VIII. Authorized Official

Name: MAHESH PATEL
Title or Position: OWNER
Credential:
Phone: 352-361-3878