Provider Demographics
NPI:1093311029
Name:SULTANA, MOUSUMI LIZA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MOUSUMI
Middle Name:LIZA
Last Name:SULTANA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:589 BERLIN CROSS KEYS RD
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-9506
Mailing Address - Country:US
Mailing Address - Phone:856-629-6453
Mailing Address - Fax:856-262-9174
Practice Address - Street 1:589 BERLIN CROSS KEYS RD
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-9506
Practice Address - Country:US
Practice Address - Phone:856-629-6453
Practice Address - Fax:856-262-9174
Is Sole Proprietor?:No
Enumeration Date:2020-12-06
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RIO3969400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist