Provider Demographics
NPI:1578738332
Name:SAHANSRA, GURDEEP SINGH (RPH)
Entity Type:Individual
Prefix:MR
First Name:GURDEEP
Middle Name:SINGH
Last Name:SAHANSRA
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 1:231 W MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-5514
Mailing Address - Country:US
Mailing Address - Phone:516-593-1505
Mailing Address - Fax:
Practice Address - Street 1:231 W MERRICK RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5514
Practice Address - Country:US
Practice Address - Phone:516-593-1505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043342183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist