Provider Demographics
NPI:1902811508
Name:THIRAJ LLC
Entity Type:Organization
Organization Name:THIRAJ LLC
Other - Org Name:SELLERSVILLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIGNESH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:551-998-5200
Mailing Address - Street 1:218 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-2529
Mailing Address - Country:US
Mailing Address - Phone:215-257-9077
Mailing Address - Fax:215-453-0633
Practice Address - Street 1:218 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-2529
Practice Address - Country:US
Practice Address - Phone:215-257-9077
Practice Address - Fax:215-453-0633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP414107L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103609542Medicaid
2086660OtherPK
4596400001Medicare NSC