Provider Demographics
NPI:1295901833
Name:SOTOMAYOR, JUSTIN ROYAL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:ROYAL
Last Name:SOTOMAYOR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3027 SETH CT
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-6027
Mailing Address - Country:US
Mailing Address - Phone:704-864-2996
Mailing Address - Fax:
Practice Address - Street 1:3027 SETH CT
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-6027
Practice Address - Country:US
Practice Address - Phone:704-864-2996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-04
Last Update Date:2008-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41321183500000X
NC19397183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist