Provider Demographics
NPI:1497078596
Name:SOMA, GURDINE (BS)
Entity Type:Individual
Prefix:MRS
First Name:GURDINE
Middle Name:
Last Name:SOMA
Suffix:
Gender:F
Credentials:BS
Other - Prefix:MISS
Other - First Name:GURDINE
Other - Middle Name:
Other - Last Name:ANDRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 ETHAN DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07727-3776
Mailing Address - Country:US
Mailing Address - Phone:732-919-1210
Mailing Address - Fax:732-919-1210
Practice Address - Street 1:11 ETHAN DR
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NJ
Practice Address - Zip Code:07727-3776
Practice Address - Country:US
Practice Address - Phone:732-919-1210
Practice Address - Fax:732-919-1210
Is Sole Proprietor?:No
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02708300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist