Healthcare Provider Details

I. General information

NPI: 1851058473
Provider Name (Legal Business Name): PUJA PANCHAL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2021
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10905 N NEBRASKA AVE
TAMPA FL
33612-5724
US

IV. Provider business mailing address

17807 ARBOR GREENE DR
TAMPA FL
33647-3139
US

V. Phone/Fax

Practice location:
  • Phone: 813-971-8401
  • Fax:
Mailing address:
  • Phone: 813-928-3061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS55227
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: