Provider Demographics
NPI:1992386049
Name:DAFTARY, SUHANI
Entity Type:Individual
Prefix:MS
First Name:SUHANI
Middle Name:
Last Name:DAFTARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 W UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-5333
Mailing Address - Country:US
Mailing Address - Phone:512-863-4671
Mailing Address - Fax:512-863-4894
Practice Address - Street 1:1220 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-5333
Practice Address - Country:US
Practice Address - Phone:512-863-4671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67909183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist