Provider Demographics
NPI:1417564899
Name:SUTHAR, MIT MANOJKUMAR (RPH)
Entity Type:Individual
Prefix:
First Name:MIT
Middle Name:MANOJKUMAR
Last Name:SUTHAR
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1773 CHANDELIER CIR E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-5553
Mailing Address - Country:US
Mailing Address - Phone:904-329-6217
Mailing Address - Fax:
Practice Address - Street 1:1773 CHANDELIER CIR E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-5553
Practice Address - Country:US
Practice Address - Phone:904-329-6217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS61675183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist