Provider Demographics
NPI:1659580793
Name:IYER, BRAGADEESH RAMAMURTI (PHARM D, CGP)
Entity Type:Individual
Prefix:DR
First Name:BRAGADEESH
Middle Name:RAMAMURTI
Last Name:IYER
Suffix:
Gender:M
Credentials:PHARM D, CGP
Other - Prefix:
Other - First Name:BIJJU
Other - Middle Name:
Other - Last Name:IYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARM D, CGP
Mailing Address - Street 1:1951 W JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-3914
Mailing Address - Country:US
Mailing Address - Phone:630-357-0280
Mailing Address - Fax:
Practice Address - Street 1:1951 W JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-3914
Practice Address - Country:US
Practice Address - Phone:630-357-0280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 50852183500000X
IL051.286131183500000X
NV13723183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist