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General NPI Number Information
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NPI Number | 1922284249
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Entity Type | Organization
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Legal Business Name | RAJ MISTRY
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Dates
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Enumeration Date | 01/16/2008
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Last Update Date | 02/07/2022
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Provider Practice Location Address
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Address Line | 3180 E FLORENCE AVE
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-5830
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Country | US
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Telephone | 323-583-4307
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Fax | 323-583-0900
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Provider Business Mailing Address
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Address Line | 3180 E FLORENCE AVE
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-5830
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Country | US
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Telephone | 323-583-4307
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Fax | 323-583-0900
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | MR. RAJ MISTRY
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Credential | B PHARM
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Telephone | 323-583-4307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHY34424
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License Number State | CA
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Taxonomy #2
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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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