Provider Demographics
NPI:1336119213
Name:NEW SUTTER PROFESSIONAL PHARMACY INC
Entity Type:Organization
Organization Name:NEW SUTTER PROFESSIONAL PHARMACY INC
Other - Org Name:SUTTER PROFESSIONAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:PHRMD
Authorized Official - Phone:916-704-9599
Mailing Address - Street 1:2300 SUTTER ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3037
Mailing Address - Country:US
Mailing Address - Phone:415-567-3223
Mailing Address - Fax:415-567-2633
Practice Address - Street 1:2300 SUTTER ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3037
Practice Address - Country:US
Practice Address - Phone:415-567-3223
Practice Address - Fax:415-567-2633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY489183336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1336119213Medicaid
0550815OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CA1336119213Medicaid