Provider Demographics
NPI:1790945673
Name:ALUMOOTTIL, ASHA J (PHARMD)
Entity Type:Individual
Prefix:
First Name:ASHA
Middle Name:J
Last Name:ALUMOOTTIL
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 1:1360 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-1922
Mailing Address - Country:US
Mailing Address - Phone:718-987-7300
Mailing Address - Fax:718-987-1305
Practice Address - Street 1:1360 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-1922
Practice Address - Country:US
Practice Address - Phone:718-987-7300
Practice Address - Fax:718-987-1305
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052210183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00825190Medicaid