Provider Demographics
NPI:1124427646
Name:MODY, PUJA RASHMI
Entity type:Individual
Prefix:
First Name:PUJA
Middle Name:RASHMI
Last Name:MODY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PUJA
Other - Middle Name:RASHMI
Other - Last Name:DOSHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5837 W DEL LAGO CIR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6204
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5837 W DEL LAGO CIR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-6204
Practice Address - Country:US
Practice Address - Phone:505-321-4234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018962183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist