Provider Demographics
NPI:1235283573
Name:SOHUM RX LLC
Entity Type:Organization
Organization Name:SOHUM RX LLC
Other - Org Name:WESTSIDE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER, LLC
Authorized Official - Prefix:
Authorized Official - First Name:BHAUMIK
Authorized Official - Middle Name:
Authorized Official - Last Name:THAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-394-0600
Mailing Address - Street 1:215 N HERMITAGE AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-5531
Mailing Address - Country:US
Mailing Address - Phone:609-394-0600
Mailing Address - Fax:609-394-5505
Practice Address - Street 1:215 N HERMITAGE AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618
Practice Address - Country:US
Practice Address - Phone:609-394-0600
Practice Address - Fax:609-394-5505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00662600333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0125156Medicaid
NJ0801070002Medicare NSC