Healthcare Provider Details

I. General information

NPI: 1942247366
Provider Name (Legal Business Name): KUMAR MAHARAJ RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2613 W HENRIETTA RD
ROCHESTER NY
14623-2327
US

IV. Provider business mailing address

2613 W HENRIETTA RD
ROCHESTER NY
14623-2327
US

V. Phone/Fax

Practice location:
  • Phone: 585-279-4950
  • Fax: 585-461-3942
Mailing address:
  • Phone: 585-279-4950
  • Fax: 585-461-3942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number36144
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: