Provider Demographics
NPI:1043727043
Name:SATYANATHAN, JAIRAJ
Entity Type:Individual
Prefix:
First Name:JAIRAJ
Middle Name:
Last Name:SATYANATHAN
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 1:790 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-2521
Mailing Address - Country:US
Mailing Address - Phone:419-447-8304
Mailing Address - Fax:419-447-8604
Practice Address - Street 1:790 W MARKET ST
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-2521
Practice Address - Country:US
Practice Address - Phone:419-447-8304
Practice Address - Fax:419-447-8604
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03215695183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist