Provider Demographics
NPI:1205002706
Name:SUNDERRAJ, JOHN S (BS PHARMACY)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:S
Last Name:SUNDERRAJ
Suffix:
Gender:M
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 SEVEN OAKS LN
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-3523
Mailing Address - Country:US
Mailing Address - Phone:845-623-6347
Mailing Address - Fax:
Practice Address - Street 1:32 SEVEN OAKS LN
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-3523
Practice Address - Country:US
Practice Address - Phone:845-623-6347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033580183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist