=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669981528
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHARMARAJ PHARMACY SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1385 DANIELLE DR
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46231-1614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-850-4299
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1385 DANIELLE DR
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46231-1614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-850-4299
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. FATAI ADEMOLA RAJI
-----------------------------------------------------
Credential | PHARND
-----------------------------------------------------
Telephone | 317-850-4299
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 26021841A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------