Provider Demographics
NPI:1194030536
Name:THIAGARAJAH, RAGAVAN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:RAGAVAN
Middle Name:
Last Name:THIAGARAJAH
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 STAFFORD PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2734
Mailing Address - Country:US
Mailing Address - Phone:609-978-4923
Mailing Address - Fax:609-978-4923
Practice Address - Street 1:209 STAFFORD PARK BLVD
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2734
Practice Address - Country:US
Practice Address - Phone:609-978-4923
Practice Address - Fax:609-978-4923
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03235900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0190055Medicaid