Provider Demographics
NPI:1356818538
Name:PATEL, POOJA VIJAY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:POOJA
Middle Name:VIJAY
Last Name:PATEL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24250 N 23RD AVE UNIT 3163
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-1989
Mailing Address - Country:US
Mailing Address - Phone:209-612-7381
Mailing Address - Fax:
Practice Address - Street 1:4811 N 83RD AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-1000
Practice Address - Country:US
Practice Address - Phone:623-247-4445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS023646183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist