Basic Information
Provider Information
NPI: 1003140112
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PATEL
FirstName: POOJA
MiddleName: VISHNU
NamePrefix: DR.
NameSuffix:  
Credential: PHARM.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 11500 WAKEHURST CT
Address2:  
City: BAKERSFIELD
State: CA
PostalCode: 933119354
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1700 MOUNT VERNON AVE
Address2:  
City: BAKERSFIELD
State: CA
PostalCode: 933064018
CountryCode: US
TelephoneNumber: 6613262362
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/22/2009
LastUpdateDate: 09/22/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1835P1200X63033CAY Pharmacy Service ProvidersPharmacistPharmacotherapy

No ID Information.


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