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NPI Code Detail

MEDICARE: AMANDA SOUROUR

MEDICARE: AMANDA SOUROUR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist28RI03833400NJ

General Provider Information

NPI Number : 1790398998
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA SOUROUR
Provider Business Mailing Address
First Line : 1303 SAINT GEORGES AVE
Second Line :
City : COLONIA
State : NJ
Zip : 07067-3925
Country : US
Telephone Number : 732-827-2904
Fax Number :
Provider Business Practice Location Address
First Line : 1303 SAINT GEORGES AVE
Second Line :
City : COLONIA
State : NJ
Zip : 07067-3925
Country : US
Telephone Number : 732-827-2904
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2020
Last Update Date : 08/26/2020

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Directions to “ AMANDA SOUROUR ” Practice Location

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