Provider Demographics
NPI:1992058044
Name:MODI, SARUNG M (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SARUNG
Middle Name:M
Last Name:MODI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 PARKWAY AVE
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-2317
Mailing Address - Country:US
Mailing Address - Phone:609-882-3456
Mailing Address - Fax:
Practice Address - Street 1:970 PARKWAY AVE
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08618-2317
Practice Address - Country:US
Practice Address - Phone:609-882-3456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03531700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist