Provider Demographics
NPI:1861741688
Name:RAJAURE, SUDHIR (RPH)
Entity type:Individual
Prefix:MR
First Name:SUDHIR
Middle Name:
Last Name:RAJAURE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 SKYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2152
Mailing Address - Country:US
Mailing Address - Phone:304-673-6056
Mailing Address - Fax:
Practice Address - Street 1:218 SKYVIEW DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3139
Practice Address - Country:US
Practice Address - Phone:304-267-3605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV7203183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7249150001Medicare NSC
WV1396158135Medicare NSC