Provider Demographics
NPI:1588295562
Name:THAKER, RAJIV NARHARI
Entity type:Individual
Prefix:MR
First Name:RAJIV
Middle Name:NARHARI
Last Name:THAKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 EDINBOROUGH DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48306-3684
Mailing Address - Country:US
Mailing Address - Phone:248-275-6608
Mailing Address - Fax:
Practice Address - Street 1:18500 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48223-2319
Practice Address - Country:US
Practice Address - Phone:313-272-5256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038285183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist