Provider Demographics
NPI:1336465541
Name:GUTMAN, SOFIYA (PHARM-D)
Entity Type:Individual
Prefix:DR
First Name:SOFIYA
Middle Name:
Last Name:GUTMAN
Suffix:
Gender:F
Credentials:PHARM-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-5709
Mailing Address - Country:US
Mailing Address - Phone:718-686-8900
Mailing Address - Fax:718-686-8910
Practice Address - Street 1:4125 18TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-5709
Practice Address - Country:US
Practice Address - Phone:718-686-8900
Practice Address - Fax:718-686-8910
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049555-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist