Provider Demographics
NPI:1861044059
Name:SULKOW, HARRISON R (PHARMD, BCACP)
Entity Type:Individual
Prefix:DR
First Name:HARRISON
Middle Name:R
Last Name:SULKOW
Suffix:
Gender:M
Credentials:PHARMD, BCACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-5318
Mailing Address - Country:US
Mailing Address - Phone:518-605-4768
Mailing Address - Fax:
Practice Address - Street 1:815 BROADWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-5318
Practice Address - Country:US
Practice Address - Phone:518-605-4768
Practice Address - Fax:646-614-8385
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-09
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0648261835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care