Provider Demographics
NPI:1083259774
Name:SHARMA-BASNET, PUJA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PUJA
Middle Name:
Last Name:SHARMA-BASNET
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:PUJA
Other - Middle Name:
Other - Last Name:SHARMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:980 E FORT UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-1714
Mailing Address - Country:US
Mailing Address - Phone:801-256-0532
Mailing Address - Fax:
Practice Address - Street 1:980 E FORT UNION BLVD
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-1714
Practice Address - Country:US
Practice Address - Phone:801-256-0532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-17
Last Update Date:2019-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7770190-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist