Healthcare Provider Details

I. General information

NPI: 1871141309
Provider Name (Legal Business Name): SIDRA BATOOL KAZMI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 NJ-45
PILESGROVE NJ
08098
US

IV. Provider business mailing address

6 BLUE GRASS WAY
GLASSBORO NJ
08028-2064
US

V. Phone/Fax

Practice location:
  • Phone: 856-769-4252
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04042400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: