Individual
MR. SANJAY JAYANTI MODHERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMACIST
Contact information
Practice address
500 E VETERANS ST, TOMAH, WI 54660-3105
(608) 372-3971
Mailing address
500 EAST VETERANS STREET, TOMAH, WI 54660-3105
(608) 372-3971
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051286008
IL
Other
Enumeration date
03/17/2010
Last updated
03/17/2010
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