Provider Demographics
NPI:1619294519
Name:SUTARIA, SAMIR (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:SAMIR
Middle Name:
Last Name:SUTARIA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14614 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-3628
Mailing Address - Country:US
Mailing Address - Phone:718-297-0099
Mailing Address - Fax:
Practice Address - Street 1:14614 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-3628
Practice Address - Country:US
Practice Address - Phone:718-297-0099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-01
Last Update Date:2010-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041629183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist