Provider Demographics
NPI:1831490697
Name:DESHPANDE, PUJA VILAS (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:PUJA
Middle Name:VILAS
Last Name:DESHPANDE
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 1:1436 YARROW CIR
Mailing Address - Street 2:
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713-3025
Mailing Address - Country:US
Mailing Address - Phone:631-413-1481
Mailing Address - Fax:
Practice Address - Street 1:200 SUNRISE MALL
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-4340
Practice Address - Country:US
Practice Address - Phone:516-799-5042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055260183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist