Provider Demographics
NPI:1326289349
Name:VODOOR, MOHAN (RPH)
Entity Type:Individual
Prefix:
First Name:MOHAN
Middle Name:
Last Name:VODOOR
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-1610
Mailing Address - Country:US
Mailing Address - Phone:732-682-5858
Mailing Address - Fax:212-491-5501
Practice Address - Street 1:2920 8TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10039-1610
Practice Address - Country:US
Practice Address - Phone:212-491-5500
Practice Address - Fax:212-491-5501
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY29075183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist