Provider Demographics
NPI:1508460650
Name:ANTOINE, SERGELYNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:SERGELYNE
Middle Name:
Last Name:ANTOINE
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 1:267 CAMBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-1905
Mailing Address - Country:US
Mailing Address - Phone:718-954-5027
Mailing Address - Fax:
Practice Address - Street 1:1011 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-7120
Practice Address - Country:US
Practice Address - Phone:908-687-3371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03700900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist