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General NPI Number Information
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NPI Number | 1699047308
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Entity Type | Individual
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Provider Name | REJANI THEKKEDATHU RAJAN PHARMD
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Gender | Female
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Dates
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Enumeration Date | 01/27/2012
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Last Update Date | 01/27/2012
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Provider Practice Location Address
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Address Line | 891 PONCE DE LEON AVE NE
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City | ATLANTA
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State | GA
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Zip | 30306-4267
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Country | US
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Telephone | 404-874-0640
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Fax |
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Provider Business Mailing Address
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Address Line | 220 26TH ST NW APARTMENT 8201
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City | ATLANTA
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State | GA
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Zip | 30309-1914
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Country | US
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Telephone | 215-688-3019
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH026335
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP444093
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License Number State | PA
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