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General NPI Number Information
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NPI Number | 1659107712
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Entity Type | Organization
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Legal Business Name | RAJBASO LLC
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Dates
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Enumeration Date | 09/13/2024
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 24930 GRATIOT AVE
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City | EASTPOINTE
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State | MI
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Zip | 48021-3317
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Country | US
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Telephone | 313-335-2126
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Fax |
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Provider Business Mailing Address
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Address Line | 13226 E JEFFERSON AVE
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City | DETROIT
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State | MI
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Zip | 48215-2704
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Country | US
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Telephone | 313-335-2126
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JITENDRAKUMAR D PATEL
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Credential |
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Telephone | 313-335-2126
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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