Provider Demographics
NPI:1811682073
Name:SHARMA, MANU
Entity type:Individual
Prefix:
First Name:MANU
Middle Name:
Last Name:SHARMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:PORT MONMOUTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07758-1228
Mailing Address - Country:US
Mailing Address - Phone:732-495-0156
Mailing Address - Fax:
Practice Address - Street 1:200 WILSON AVE
Practice Address - Street 2:
Practice Address - City:PORT MONMOUTH
Practice Address - State:NJ
Practice Address - Zip Code:07758-1228
Practice Address - Country:US
Practice Address - Phone:732-495-0156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RW04121300183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician