Provider Demographics
NPI:1982910022
Name:SOKOLOVSKAYA, MARINA
Entity Type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:
Last Name:SOKOLOVSKAYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 N MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-2144
Mailing Address - Country:US
Mailing Address - Phone:973-535-1007
Mailing Address - Fax:
Practice Address - Street 1:1200 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-2070
Practice Address - Country:US
Practice Address - Phone:973-375-3211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02592000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist