Provider Demographics
NPI:1659791432
Name:MODI-PANDEJEE, HENA (PHARM D)
Entity Type:Individual
Prefix:
First Name:HENA
Middle Name:
Last Name:MODI-PANDEJEE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W HOLT AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-3200
Mailing Address - Country:US
Mailing Address - Phone:414-769-8990
Mailing Address - Fax:414-769-8997
Practice Address - Street 1:250 W HOLT AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-3200
Practice Address - Country:US
Practice Address - Phone:414-769-8990
Practice Address - Fax:414-769-8990
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-21
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH027036183500000X
WI19693-401835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist