Provider Demographics
NPI:1457658528
Name:POOJARY, SHIVAPRAKASH T (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:SHIVAPRAKASH
Middle Name:T
Last Name:POOJARY
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6057 WHITE HORSE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29611-3842
Mailing Address - Country:US
Mailing Address - Phone:864-295-0243
Mailing Address - Fax:864-295-1959
Practice Address - Street 1:6057 WHITE HORSE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611-3842
Practice Address - Country:US
Practice Address - Phone:864-295-0243
Practice Address - Fax:864-295-1959
Is Sole Proprietor?:No
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12755183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist