Provider Demographics
NPI:1043462179
Name:MUKHTAR, SUMARA (PHARMD)
Entity type:Individual
Prefix:
First Name:SUMARA
Middle Name:
Last Name:MUKHTAR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:SUMARA
Other - Middle Name:
Other - Last Name:RASHID
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:180 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-3649
Mailing Address - Country:US
Mailing Address - Phone:212-243-0129
Mailing Address - Fax:212-243-2467
Practice Address - Street 1:180 W 20TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-3649
Practice Address - Country:US
Practice Address - Phone:212-243-0129
Practice Address - Fax:212-243-2467
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052934183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist