Provider Demographics
NPI:1194358945
Name:SHADDARSHANAM, HEMA
Entity Type:Individual
Prefix:MRS
First Name:HEMA
Middle Name:
Last Name:SHADDARSHANAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BERGEN TPKE
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07660-2340
Mailing Address - Country:US
Mailing Address - Phone:908-241-6337
Mailing Address - Fax:908-241-6338
Practice Address - Street 1:2 BERGEN TPKE
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07660-2340
Practice Address - Country:US
Practice Address - Phone:908-241-6337
Practice Address - Fax:908-241-6338
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03106700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist