Jie Giok Rahardja, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

62966 Issued in CA

Practice address

401 Bicentennial Way
Santa Rosa, CA 95403-2149

Phone

(707) 393-4652

NPI assigned

Aug 14, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1313280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313280000000",
    "number": "1013296656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 VERDE CT",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949541545",
            "telephone_number": "707-769-9361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 BICENTENNIAL WAY",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954032149",
            "telephone_number": "707-393-4652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAHARDJA",
        "first_name": "JIE GIOK",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-08-14",
        "last_updated": "2011-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "62966",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jesse Rael, MD
• Henry Rafferty
• Denise Janet Ragozzino
• Suzanne Lydia Ragsdale, FNP-C, MSN
• Alena C Ragueneau, RADT-1
• Bahareh Rahmattan
• Ralph E Dilisio MD FCCP Inc.
• Ralph P. Hoyal, DPM
• Alyssa Ramage
• Avinash Nari Ramchandani, MD

• Pharmacist in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Pharmacist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.