Provider Demographics
NPI:1982926366
Name:SHELL, SOFYA
Entity Type:Individual
Prefix:
First Name:SOFYA
Middle Name:
Last Name:SHELL
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 1:25 PAMRAPO CT E
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-2847
Mailing Address - Country:US
Mailing Address - Phone:201-389-3763
Mailing Address - Fax:718-934-1966
Practice Address - Street 1:572 PATERSON AVE
Practice Address - Street 2:
Practice Address - City:E RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07073-1106
Practice Address - Country:US
Practice Address - Phone:201-507-3602
Practice Address - Fax:201-507-3607
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050715-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist