Provider Demographics
NPI:1124696968
Name:RAGHAVAN PILLAI, RAJEEV
Entity type:Individual
Prefix:MR
First Name:RAJEEV
Middle Name:
Last Name:RAGHAVAN PILLAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2306 BLUE HILL RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-7304
Mailing Address - Country:US
Mailing Address - Phone:919-510-5121
Mailing Address - Fax:
Practice Address - Street 1:2366 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-5339
Practice Address - Country:US
Practice Address - Phone:203-666-4000
Practice Address - Fax:203-666-4265
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT0011727183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist