Provider Demographics
NPI:1265702138
Name:MESTERMAN, SVETLANA (PHARMD)
Entity type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:MESTERMAN
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 1:1138 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-2331
Mailing Address - Country:US
Mailing Address - Phone:973-773-5848
Mailing Address - Fax:212-808-4963
Practice Address - Street 1:1138 MAIN AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2331
Practice Address - Country:US
Practice Address - Phone:973-773-5848
Practice Address - Fax:973-773-4790
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2022-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03847700183500000X
CT0012114183500000X
NY059070183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI03847700OtherPHARMACY LICENCE
CTPCT.0012114OtherPHARMACIST LICENSE
NY059070OtherNY BOARD OF PHAMRACY