Provider Demographics
NPI:1730743683
Name:SOOMRO, MISBAH
Entity type:Individual
Prefix:
First Name:MISBAH
Middle Name:
Last Name:SOOMRO
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:PO BOX 10384
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-1384
Mailing Address - Country:US
Mailing Address - Phone:310-493-7225
Mailing Address - Fax:
Practice Address - Street 1:5030 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-6317
Practice Address - Country:US
Practice Address - Phone:562-984-2813
Practice Address - Fax:562-428-3041
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50005183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist