Healthcare Provider Details

I. General information

NPI: 1104073196
Provider Name (Legal Business Name): MANISH R PUJARA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 08/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2343 ARTHUR AVE
BRONX NY
10458-8111
US

IV. Provider business mailing address

2343 ARTHUR AVENUE
BRONX NY
10458
US

V. Phone/Fax

Practice location:
  • Phone: 718-561-4040
  • Fax: 718-561-5237
Mailing address:
  • Phone: 718-561-4040
  • Fax: 718-561-5237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number044836
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: