Provider Demographics
NPI:1659716702
Name:SUNNONGMUANG, SHERYL A (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:SHERYL
Middle Name:A
Last Name:SUNNONGMUANG
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 1:300 CENTRAL AVE
Mailing Address - Street 2:PHARMACY DEPARTMENT
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2819
Mailing Address - Country:US
Mailing Address - Phone:973-266-4483
Mailing Address - Fax:973-266-8483
Practice Address - Street 1:300 CENTRAL AVE
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2819
Practice Address - Country:US
Practice Address - Phone:973-266-4483
Practice Address - Fax:973-266-8483
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02980500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI02980500OtherREGISTERED PHARMACIST LICENSE NUMBER