Healthcare Provider Details

I. General information

NPI: 1679208045
Provider Name (Legal Business Name): POOJA POLADIA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 ASHLEY AVE # MSC584
CHARLESTON SC
29425-8907
US

IV. Provider business mailing address

150 ASHLEY AVE # MSC584
CHARLESTON SC
29425-3014
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-1414
  • Fax:
Mailing address:
  • Phone: 816-398-3362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number43534
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: