Provider Demographics
NPI:1538803291
Name:RAJO DISTRIBUTORS L.L.C
Entity type:Organization
Organization Name:RAJO DISTRIBUTORS L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUSAB
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULKADIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-250-2486
Mailing Address - Street 1:8001 33RD AVE S UNIT B628
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4621
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1025 CURRIE AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-1310
Practice Address - Country:US
Practice Address - Phone:612-605-1809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA422685700Medicaid