Healthcare Provider Details

I. General information

NPI: 1609246727
Provider Name (Legal Business Name): PRAJAL RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 S YORK RD STE D
HATBORO PA
19040-3970
US

IV. Provider business mailing address

420 S YORK RD STE D
HATBORO PA
19040-3970
US

V. Phone/Fax

Practice location:
  • Phone: 215-443-9999
  • Fax: 215-442-9999
Mailing address:
  • Phone: 215-443-9999
  • Fax: 215-442-9999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP482604
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DHRUPAL PATEL
Title or Position: OFFICER
Credential:
Phone: 215-443-9999