Provider Demographics
NPI:1851058473
Name:PANCHAL, PUJA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PUJA
Middle Name:
Last Name:PANCHAL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17807 ARBOR GREENE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3139
Mailing Address - Country:US
Mailing Address - Phone:813-928-3061
Mailing Address - Fax:
Practice Address - Street 1:10905 N NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-5724
Practice Address - Country:US
Practice Address - Phone:813-971-8401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS55227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist