Provider Demographics
NPI:1508188020
Name:SAMBAT, KATHLYN MONTERO (RPH)
Entity Type:Individual
Prefix:
First Name:KATHLYN
Middle Name:MONTERO
Last Name:SAMBAT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5844 43RD AVE APT 1F
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4816
Mailing Address - Country:US
Mailing Address - Phone:718-675-9070
Mailing Address - Fax:
Practice Address - Street 1:542-576 SECOND AVENUE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-213-9887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053423183500000X
NJ28RI03124400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist