Provider Demographics
NPI:1437449394
Name:JAIN, POOJA (RPH)
Entity Type:Individual
Prefix:
First Name:POOJA
Middle Name:
Last Name:JAIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 S MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-4366
Mailing Address - Country:US
Mailing Address - Phone:517-263-0603
Mailing Address - Fax:
Practice Address - Street 1:1200 S MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-4366
Practice Address - Country:US
Practice Address - Phone:517-263-0603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038987183500000X
OH03129904183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist