Provider Demographics
NPI:1659603272
Name:SOJERI, MARJAN HADI (BS)
Entity Type:Individual
Prefix:MRS
First Name:MARJAN
Middle Name:HADI
Last Name:SOJERI
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 SOUTHBERRY LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-2828
Mailing Address - Country:US
Mailing Address - Phone:516-749-2351
Mailing Address - Fax:
Practice Address - Street 1:1123 JERUSALEM AVE
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-3004
Practice Address - Country:US
Practice Address - Phone:516-505-1230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-07
Last Update Date:2010-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050067-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist