Provider Demographics
NPI:1972105591
Name:ASIM, SUFIAN
Entity type:Individual
Prefix:
First Name:SUFIAN
Middle Name:
Last Name:ASIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-2519
Mailing Address - Country:US
Mailing Address - Phone:252-824-0342
Mailing Address - Fax:
Practice Address - Street 1:1519 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-2519
Practice Address - Country:US
Practice Address - Phone:252-824-0342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30115183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist