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General NPI Number Information
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NPI Number | 1497031470
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Entity Type | Individual
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Provider Name | SOSAMMA M OOMMEN
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Gender | Female
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Dates
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Enumeration Date | 10/22/2011
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Last Update Date | 10/22/2011
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Provider Practice Location Address
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Address Line | 3820 52ND ST
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City | KENOSHA
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State | WI
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Zip | 53144-2624
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Country | US
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Telephone | 262-652-9665
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Fax | 262-652-0896
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Provider Business Mailing Address
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Address Line | 3820 52ND ST
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City | KENOSHA
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State | WI
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Zip | 53144-2624
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Country | US
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Telephone | 262-652-9665
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Fax | 262-652-0896
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 13725-040
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License Number State | WI
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