Provider Demographics
NPI:1497932057
Name:JAGNANDAN, REHANA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:REHANA
Middle Name:
Last Name:JAGNANDAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2027 AMHERST AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-2337
Mailing Address - Country:US
Mailing Address - Phone:516-241-2321
Mailing Address - Fax:
Practice Address - Street 1:1 E MERRICK RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5814
Practice Address - Country:US
Practice Address - Phone:516-595-0595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052048183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4016521571OtherPHARMACY