Provider Demographics
NPI:1720324049
Name:TEJWANI, NARENDRA G (PHD)
Entity Type:Individual
Prefix:
First Name:NARENDRA
Middle Name:G
Last Name:TEJWANI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 CLEMSON BLVD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1318
Mailing Address - Country:US
Mailing Address - Phone:864-231-1176
Mailing Address - Fax:864-231-1181
Practice Address - Street 1:3801 CLEMSON BLVD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1318
Practice Address - Country:US
Practice Address - Phone:864-231-1176
Practice Address - Fax:864-231-1181
Is Sole Proprietor?:No
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12758183500000X
GARPH026746183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist