Provider Demographics
NPI:1497023816
Name:KOMMA, SATHEESH
Entity Type:Individual
Prefix:
First Name:SATHEESH
Middle Name:
Last Name:KOMMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 BARNUM AVENUE CUTOFF
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-5111
Mailing Address - Country:US
Mailing Address - Phone:203-502-7629
Mailing Address - Fax:
Practice Address - Street 1:150 BARNUM AVENUE CUTOFF
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-5111
Practice Address - Country:US
Practice Address - Phone:203-502-7629
Practice Address - Fax:203-502-7655
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.00102291835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist