Provider Demographics
NPI:1871141309
Name:KAZMI, SIDRA BATOOL
Entity type:Individual
Prefix:
First Name:SIDRA
Middle Name:BATOOL
Last Name:KAZMI
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 1:6 BLUE GRASS WAY
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-2064
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:865 NJ-45
Practice Address - Street 2:
Practice Address - City:PILESGROVE
Practice Address - State:NJ
Practice Address - Zip Code:08098
Practice Address - Country:US
Practice Address - Phone:856-769-4252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04042400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist