Provider Demographics
NPI:1346843547
Name:UDE, SANDRA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:UDE
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 1:32 KOSTER BLVD APT 1C
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-4272
Mailing Address - Country:US
Mailing Address - Phone:732-715-1025
Mailing Address - Fax:
Practice Address - Street 1:1501 BAYSHORE RD
Practice Address - Street 2:
Practice Address - City:VILLAS
Practice Address - State:NJ
Practice Address - Zip Code:08251-2302
Practice Address - Country:US
Practice Address - Phone:609-886-1166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03915500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI03915500OtherLICENSE