Provider Demographics
NPI:1447565502
Name:PERUMKULAM, POORNIMA S (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:POORNIMA
Middle Name:S
Last Name:PERUMKULAM
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 GOLDEN MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-9393
Mailing Address - Country:US
Mailing Address - Phone:856-269-9361
Mailing Address - Fax:
Practice Address - Street 1:375 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:ATCO
Practice Address - State:NJ
Practice Address - Zip Code:08004-2228
Practice Address - Country:US
Practice Address - Phone:856-768-0911
Practice Address - Fax:856-768-0791
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03000600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist