Provider Demographics
NPI:1669077087
Name:KUMAR, MANISHA (PHARMD)
Entity type:Individual
Prefix:
First Name:MANISHA
Middle Name:
Last Name:KUMAR
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 1:6102 LITTLE NECK PKWY FL 1
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-2419
Mailing Address - Country:US
Mailing Address - Phone:917-470-6640
Mailing Address - Fax:
Practice Address - Street 1:25405 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004-1613
Practice Address - Country:US
Practice Address - Phone:718-347-7313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI-063260183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist