Provider Demographics
NPI:1528381639
Name:SUCATO, TINA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:
Last Name:SUCATO
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 1:312 NETHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-2715
Mailing Address - Country:US
Mailing Address - Phone:845-229-2367
Mailing Address - Fax:
Practice Address - Street 1:312 NETHERWOOD RD
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-2715
Practice Address - Country:US
Practice Address - Phone:845-229-2367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038868183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist