Provider Demographics
NPI:1760752687
Name:POLASI, PADMAJA (MS, RPH)
Entity Type:Individual
Prefix:MRS
First Name:PADMAJA
Middle Name:
Last Name:POLASI
Suffix:
Gender:F
Credentials:MS, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W DEUCE OF CLUBS
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-6214
Mailing Address - Country:US
Mailing Address - Phone:928-532-5656
Mailing Address - Fax:
Practice Address - Street 1:900 W DEUCE OF CLUBS
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-6214
Practice Address - Country:US
Practice Address - Phone:928-532-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018935183500000X
OHRPH.03228486-2183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist