Provider Demographics
NPI:1376965814
Name:PODDAR, ANOOP
Entity Type:Individual
Prefix:
First Name:ANOOP
Middle Name:
Last Name:PODDAR
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 1:310 LIBERTY ST APT 44
Mailing Address - Street 2:
Mailing Address - City:LITTLE FERRY
Mailing Address - State:NJ
Mailing Address - Zip Code:07643-1364
Mailing Address - Country:US
Mailing Address - Phone:973-615-7346
Mailing Address - Fax:
Practice Address - Street 1:310 LIBERTY ST APT 44
Practice Address - Street 2:
Practice Address - City:LITTLE FERRY
Practice Address - State:NJ
Practice Address - Zip Code:07643-1364
Practice Address - Country:US
Practice Address - Phone:973-615-7346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03617500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI03617500OtherPHARMACIST LICENSE