MEDICARE: GIRIRAJ CORPORATION

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	333600000X	Pharmacy
2	3336L0003X	Long Term Care Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PHY55475	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2168254	OTHER		PK

General Provider Information

NPI Number	:	1740729763
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIRIRAJ CORPORATION

Provider Business Mailing Address
First Line	:	24825 ALESSANDRO BLVD STE 2
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92553-5851
Country	:	US
Telephone Number	:	951-243-2530
Fax Number	:	951-243-2554

Provider Business Practice Location Address
First Line	:	24825 ALESSANDRO BLVD STE 2
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92553-5851
Country	:	US
Telephone Number	:	951-243-2530
Fax Number	:	951-243-2554

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHIRAG RAKHOLIA
Credential	:
Telephone Number	:	951-243-2530

Provider Enumeration Date	:	02/23/2017
Last Update Date	:	04/16/2021

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Directions to “GIRIRAJ CORPORATION ” Practice Location

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