MEDICARE: RAKESH LAXMIKANT RAJGANDHI

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	28RI02711300	NJ

General Provider Information

NPI Number	:	1902550114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAKESH LAXMIKANT RAJGANDHI

Provider Business Mailing Address
First Line	:	1463 FINNEGAN LN UNIT 11
Second Line	:
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-5025
Country	:	US
Telephone Number	:	732-658-3922
Fax Number	:	732-658-3923

Provider Business Practice Location Address
First Line	:	1463 FINNEGAN LN UNIT 11
Second Line	:
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-5025
Country	:	US
Telephone Number	:	732-658-3922
Fax Number	:	732-658-3923

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

Provider Enumeration Date	:	02/07/2022
Last Update Date	:	02/07/2022

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