Provider Demographics
NPI:1356945083
Name:SUTAS, ERNESTAS (PHARMD)
Entity type:Individual
Prefix:
First Name:ERNESTAS
Middle Name:
Last Name:SUTAS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:BORGER
Mailing Address - State:TX
Mailing Address - Zip Code:79007-2223
Mailing Address - Country:US
Mailing Address - Phone:773-351-6535
Mailing Address - Fax:
Practice Address - Street 1:230 N CEDAR ST
Practice Address - Street 2:
Practice Address - City:BORGER
Practice Address - State:TX
Practice Address - Zip Code:79007-4026
Practice Address - Country:US
Practice Address - Phone:806-273-1433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65740183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty