Provider Demographics
NPI:1912270612
Name:BANERJI, MADHUMITA
Entity Type:Individual
Prefix:MRS
First Name:MADHUMITA
Middle Name:
Last Name:BANERJI
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 1:10908 MOUNT ROYAL AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-4481
Mailing Address - Country:US
Mailing Address - Phone:702-240-3171
Mailing Address - Fax:702-740-5310
Practice Address - Street 1:9300 W SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5351
Practice Address - Country:US
Practice Address - Phone:702-228-2480
Practice Address - Fax:702-228-8589
Is Sole Proprietor?:No
Enumeration Date:2012-02-12
Last Update Date:2012-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15405183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist