Healthcare Provider Details

I. General information

NPI: 1225398399
Provider Name (Legal Business Name): ERAJ RX CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 07/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7-9 CROSS ST
METHEUN MA
01844
US

IV. Provider business mailing address

7-9 CROSS ST
METHEUN MA
01844
US

V. Phone/Fax

Practice location:
  • Phone: 978-794-1111
  • Fax:
Mailing address:
  • Phone: 978-794-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPENIDNG
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierS100114840
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerMEDICARE PTAN

VIII. Authorized Official

Name: JITENDRA G PATEL
Title or Position: OWNER/PHARMACY MANAGER
Credential:
Phone: 978-794-1111