Provider Demographics
NPI:1558980813
Name:SONI, AMBIKA (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMBIKA
Middle Name:
Last Name:SONI
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 1:2103 N VETERANS PKWY UNIT 3
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-0908
Mailing Address - Country:US
Mailing Address - Phone:309-664-1333
Mailing Address - Fax:
Practice Address - Street 1:2103 N VETERANS PKWY UNIT 3
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-0908
Practice Address - Country:US
Practice Address - Phone:309-664-1333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-15
Last Update Date:2020-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.302775183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist