Provider Demographics
NPI:1538412879
Name:PATEL, PUJA NARENDRA (PHARMD)
Entity type:Individual
Prefix:
First Name:PUJA
Middle Name:NARENDRA
Last Name:PATEL
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 1:2000 DRISCOLL RD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-4446
Mailing Address - Country:US
Mailing Address - Phone:847-409-8121
Mailing Address - Fax:
Practice Address - Street 1:2000 DRISCOLL RD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-4446
Practice Address - Country:US
Practice Address - Phone:847-409-8121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-24
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81916183500000X
MI5302041622183500000X
IL295951183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist