MEDICARE: NEENA OOMMEN

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
1	183500000X	Pharmacist	452114	PA

General Provider Information

NPI Number	:	1073020111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEENA OOMMEN

Provider Business Mailing Address
First Line	:	347 OLD TAPPAN RD
Second Line	:
City	:	OLD TAPPAN
State	:	NJ
Zip	:	07675-6805
Country	:	US
Telephone Number	:	201-364-1246
Fax Number	:

Provider Business Practice Location Address
First Line	:	4390 RICHMOND ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19137-1912
Country	:	US
Telephone Number	:	215-533-6564
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2018
Last Update Date	:	01/10/2018

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Directions to “ NEENA OOMMEN ” Practice Location

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