Provider Demographics
NPI:1457628901
Name:SUTORIS, JAY ROBERT (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:ROBERT
Last Name:SUTORIS
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 1:1212 CREEKMOOR DR
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-7806
Mailing Address - Country:US
Mailing Address - Phone:515-988-8866
Mailing Address - Fax:
Practice Address - Street 1:9400 E STATE ROUTE 350
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-6509
Practice Address - Country:US
Practice Address - Phone:816-358-5988
Practice Address - Fax:816-358-6885
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20063183500000X
MO2008029243183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist