Provider Demographics
NPI:1073280251
Name:THIAGARAJAH, DENESH CANDIAH (PHAMD)
Entity Type:Individual
Prefix:
First Name:DENESH
Middle Name:CANDIAH
Last Name:THIAGARAJAH
Suffix:
Gender:M
Credentials:PHAMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 DUTCH FORK RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8787
Mailing Address - Country:US
Mailing Address - Phone:803-749-7099
Mailing Address - Fax:
Practice Address - Street 1:1251 DUTCH FORK RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-8787
Practice Address - Country:US
Practice Address - Phone:803-749-7099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13706183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist