Provider Demographics
NPI:1801187141
Name:RENGARAJAN, JEGANNATHAN (RPH)
Entity type:Individual
Prefix:MR
First Name:JEGANNATHAN
Middle Name:
Last Name:RENGARAJAN
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 1:2024 UNIVERSE CT
Mailing Address - Street 2:
Mailing Address - City:NOLENSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37135-9554
Mailing Address - Country:US
Mailing Address - Phone:615-668-8425
Mailing Address - Fax:
Practice Address - Street 1:2615 FRANKLIN PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-3007
Practice Address - Country:US
Practice Address - Phone:615-298-4806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27464183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist