Provider Demographics
NPI:1659791432
Name:MODI-PANDEJEE, HENA (PHARM D)
Entity type:Individual
Prefix:
First Name:HENA
Middle Name:
Last Name:MODI-PANDEJEE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12338 W COLD SPRING RD
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-2439
Mailing Address - Country:US
Mailing Address - Phone:912-571-9071
Mailing Address - Fax:
Practice Address - Street 1:2600 S 108TH ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-1926
Practice Address - Country:US
Practice Address - Phone:414-545-0385
Practice Address - Fax:414-203-4323
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-21
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH027036183500000X
WI19693-401835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist