Provider Demographics
NPI:1134283435
Name:SUKAMTO, MARIA (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:SUKAMTO
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 MOONBEAM DR
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-5229
Mailing Address - Country:US
Mailing Address - Phone:323-261-1734
Mailing Address - Fax:
Practice Address - Street 1:2911 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-1025
Practice Address - Country:US
Practice Address - Phone:213-480-6588
Practice Address - Fax:213-480-6582
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 39288183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist