Provider Demographics
NPI:1275609083
Name:SHUTTARI, SAEED (PHARMACIST RPH)
Entity Type:Individual
Prefix:
First Name:SAEED
Middle Name:
Last Name:SHUTTARI
Suffix:
Gender:M
Credentials:PHARMACIST RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 29 QUEENS BLVD
Mailing Address - Street 2:3F
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1057
Mailing Address - Country:US
Mailing Address - Phone:718-459-0704
Mailing Address - Fax:
Practice Address - Street 1:37-16 3RD AVE
Practice Address - Street 2:EZ SUPER PHARMACY
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456
Practice Address - Country:US
Practice Address - Phone:718-992-1204
Practice Address - Fax:718-992-2501
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034271183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist