Provider Demographics
NPI:1467052852
Name:DEWOOLKAR, ANUYA VINAYAK (RPH,MS)
Entity Type:Individual
Prefix:
First Name:ANUYA
Middle Name:VINAYAK
Last Name:DEWOOLKAR
Suffix:
Gender:F
Credentials:RPH,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8350 SHAVER RD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-5441
Mailing Address - Country:US
Mailing Address - Phone:269-323-3959
Mailing Address - Fax:269-323-8026
Practice Address - Street 1:8350 SHAVER RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-5441
Practice Address - Country:US
Practice Address - Phone:269-323-3959
Practice Address - Fax:269-323-8026
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302033747183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist