Provider Demographics
NPI:1538942651
Name:RAKHOLIA, RAJ (PHARMD)
Entity type:Individual
Prefix:
First Name:RAJ
Middle Name:
Last Name:RAKHOLIA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 N BETH ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-3334
Mailing Address - Country:US
Mailing Address - Phone:714-595-1405
Mailing Address - Fax:
Practice Address - Street 1:1222 W 5TH ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-2739
Practice Address - Country:US
Practice Address - Phone:909-884-0128
Practice Address - Fax:909-381-8326
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87642183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist