Provider Demographics
NPI:1629293097
Name:GOHEL, SURESHCHANDRA T (RPH)
Entity Type:Individual
Prefix:
First Name:SURESHCHANDRA
Middle Name:T
Last Name:GOHEL
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 1:839 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-4412
Mailing Address - Country:US
Mailing Address - Phone:631-421-5381
Mailing Address - Fax:631-421-5182
Practice Address - Street 1:839 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4412
Practice Address - Country:US
Practice Address - Phone:631-421-5381
Practice Address - Fax:631-421-5182
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038474183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist