Provider Demographics
NPI:1154642510
Name:GORREPATI, SUJATA
Entity Type:Individual
Prefix:
First Name:SUJATA
Middle Name:
Last Name:GORREPATI
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 1:2105 ROUTE 35
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-1301
Mailing Address - Country:US
Mailing Address - Phone:732-706-5321
Mailing Address - Fax:732-706-5321
Practice Address - Street 1:2105 ROUTE 35
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-1301
Practice Address - Country:US
Practice Address - Phone:732-706-5321
Practice Address - Fax:732-706-5321
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02893200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist