Provider Demographics
NPI:1619149689
Name:DEVAN, RAJAN (RPH)
Entity Type:Individual
Prefix:
First Name:RAJAN
Middle Name:
Last Name:DEVAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 BEAVER AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-3815
Mailing Address - Country:US
Mailing Address - Phone:515-279-4382
Mailing Address - Fax:515-255-6079
Practice Address - Street 1:1819 BEAVER AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-3815
Practice Address - Country:US
Practice Address - Phone:515-279-4382
Practice Address - Fax:515-255-6079
Is Sole Proprietor?:No
Enumeration Date:2008-03-30
Last Update Date:2008-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19490183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA19490OtherBOARD OF PHARMACY