Provider Demographics
NPI:1922478452
Name:AHUJA, POONAM
Entity Type:Individual
Prefix:
First Name:POONAM
Middle Name:
Last Name:AHUJA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43729 CAMERON HILLS DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-5971
Mailing Address - Country:US
Mailing Address - Phone:510-289-7793
Mailing Address - Fax:510-366-9849
Practice Address - Street 1:4020 FREMONT HUB
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1322
Practice Address - Country:US
Practice Address - Phone:510-791-9108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-26
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist