Provider Demographics
NPI:1194318170
Name:MAZUMDER, SARMISTHA
Entity type:Individual
Prefix:
First Name:SARMISTHA
Middle Name:
Last Name:MAZUMDER
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:CVS PHARMACY
Mailing Address - Street 2:9140 GUILBEAU RD,
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CVS PHARMACY #1057
Practice Address - Street 2:9140 GUILBEAU RD,
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250
Practice Address - Country:US
Practice Address - Phone:210-520-5183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66229183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist