Provider Demographics
NPI:1710478193
Name:SULTANA, NUSRAT
Entity Type:Individual
Prefix:
First Name:NUSRAT
Middle Name:
Last Name:SULTANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 FLUSHING RD STE 2
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-4730
Mailing Address - Country:US
Mailing Address - Phone:810-624-2496
Mailing Address - Fax:
Practice Address - Street 1:1201 FLUSHING RD STE 2
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-4730
Practice Address - Country:US
Practice Address - Phone:810-624-2496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302039733183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist