Provider Demographics
NPI:1467915660
Name:SURAPANENI, SAI SUJANA (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:SAI SUJANA
Middle Name:
Last Name:SURAPANENI
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 WASHINGTON BLVD APT 1013
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-2045
Mailing Address - Country:US
Mailing Address - Phone:516-288-8198
Mailing Address - Fax:
Practice Address - Street 1:119 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-2500
Practice Address - Country:US
Practice Address - Phone:201-432-6968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-13
Last Update Date:2019-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03998900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI03998900OtherPHARMACIST LICENSE