Provider Demographics
NPI:1679705578
Name:SOOD, VISHAL (RPH)
Entity type:Individual
Prefix:MR
First Name:VISHAL
Middle Name:
Last Name:SOOD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ASBURY PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-5910
Mailing Address - Country:US
Mailing Address - Phone:732-774-3400
Mailing Address - Fax:732-774-8698
Practice Address - Street 1:814 MAIN ST
Practice Address - Street 2:
Practice Address - City:ASBURY PARK
Practice Address - State:NJ
Practice Address - Zip Code:07712-5910
Practice Address - Country:US
Practice Address - Phone:732-774-3400
Practice Address - Fax:732-774-8698
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00694400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist