Provider Demographics
NPI:1578731360
Name:SOHAN, MATA SAKTI (BPHARM)
Entity Type:Individual
Prefix:MRS
First Name:MATA
Middle Name:SAKTI
Last Name:SOHAN
Suffix:
Gender:F
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MOUNTVIEW RD
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-3226
Mailing Address - Country:US
Mailing Address - Phone:973-539-5862
Mailing Address - Fax:
Practice Address - Street 1:123 E MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2644
Practice Address - Country:US
Practice Address - Phone:973-586-3688
Practice Address - Fax:973-586-0618
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01966200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI01966200OtherRPH STATE LICENSE