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NPI Code Detail

MEDICARE: AJANAA JEGANATHAN

MEDICARE: AJANAA JEGANATHAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist28RI03785400NJ

General Provider Information

NPI Number : 1689278525
Entity Type Code : Individual
Provider Name (Legal Business Name) : AJANAA JEGANATHAN
Provider Business Mailing Address
First Line : 178 MORRIS AVE
Second Line :
City : SPRINGFIELD
State : NJ
Zip : 07081-1217
Country : US
Telephone Number : 973-379-8771
Fax Number :
Provider Business Practice Location Address
First Line : 178 MORRIS AVE
Second Line :
City : SPRINGFIELD
State : NJ
Zip : 07081-1217
Country : US
Telephone Number : 973-379-8771
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/22/2020
Last Update Date : 11/22/2020

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