Provider Demographics
NPI:1215240239
Name:HANSARAJ INC
Entity type:Organization
Organization Name:HANSARAJ INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANAKKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-889-7239
Mailing Address - Street 1:3231 TAMIAMI TRL G
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8031
Mailing Address - Country:US
Mailing Address - Phone:941-889-7239
Mailing Address - Fax:941-889-7236
Practice Address - Street 1:3231 TAMIAMI TRL G
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8031
Practice Address - Country:US
Practice Address - Phone:941-889-7239
Practice Address - Fax:941-889-7236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
FLPH247493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002806601Medicaid
FL002806600Medicaid
2125884OtherPK
FL002806600Medicaid