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NPI Code Detail

MEDICARE: CHENZIRA RAPHAEL I

MEDICARE: CHENZIRA RAPHAEL I
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
1183500000XPharmacistRP451225PA
2183500000XPharmacist28RI03904700NJ

General Provider Information

NPI Number : 1619411923
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHENZIRA RAPHAEL I
Provider Business Mailing Address
First Line : 101 S MAIN ST
Second Line :
City : FORKED RIVER
State : NJ
Zip : 08731-3624
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 101 S MAIN ST
Second Line :
City : FORKED RIVER
State : NJ
Zip : 08731-3624
Country : US
Telephone Number : 609-242-0066
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2016
Last Update Date : 03/17/2018

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Directions to “ CHENZIRA RAPHAEL I ” Practice Location

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