Provider Demographics
NPI:1780999607
Name:NANJI, SHRUTI MODY (PHARMD)
Entity type:Individual
Prefix:
First Name:SHRUTI
Middle Name:MODY
Last Name:NANJI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:SHRUTI
Other - Middle Name:M
Other - Last Name:MODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:35 HUDSON ST
Mailing Address - Street 2:APT 2001 W
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-6606
Mailing Address - Country:US
Mailing Address - Phone:510-364-3108
Mailing Address - Fax:
Practice Address - Street 1:701 FRANK E RODGERS BLVD N
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NJ
Practice Address - Zip Code:07029-2627
Practice Address - Country:US
Practice Address - Phone:973-483-8228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03341000183500000X
CARPH55439183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist