Provider Demographics
NPI:1770908881
Name:OOMMEN, LIZ (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:LIZ
Middle Name:
Last Name:OOMMEN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607-2720
Mailing Address - Country:US
Mailing Address - Phone:516-528-3182
Mailing Address - Fax:
Practice Address - Street 1:9 CITY PL
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-3331
Practice Address - Country:US
Practice Address - Phone:914-821-0013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-26
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0012377183500000X
NY059992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist