MEDICARE: MR. RAJIV NARHARI THAKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302038285	MI

General Provider Information

NPI Number	:	1588295562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAJIV NARHARI THAKER

Provider Business Mailing Address
First Line	:	3720 EDINBOROUGH DR
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48306-3684
Country	:	US
Telephone Number	:	248-275-6608
Fax Number	:

Provider Business Practice Location Address
First Line	:	18500 GRAND RIVER AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48223-2319
Country	:	US
Telephone Number	:	313-272-5256
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2020
Last Update Date	:	01/29/2020

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