Provider Demographics
NPI:1760738744
Name:MOHANTY, SARITA LISA (PHARM D)
Entity Type:Individual
Prefix:
First Name:SARITA
Middle Name:LISA
Last Name:MOHANTY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 W 8TH ST APT 5R
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-9017
Mailing Address - Country:US
Mailing Address - Phone:401-996-2647
Mailing Address - Fax:
Practice Address - Street 1:61 W 8TH ST APT 5R
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-9017
Practice Address - Country:US
Practice Address - Phone:401-996-2647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056669183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist