Provider Demographics
NPI:1811176316
Name:GUNDA, SAISATISH (PHARMACIST)
Entity type:Individual
Prefix:
First Name:SAISATISH
Middle Name:
Last Name:GUNDA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2217
Mailing Address - Country:US
Mailing Address - Phone:732-321-4015
Mailing Address - Fax:
Practice Address - Street 1:20 W 135TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-2534
Practice Address - Country:US
Practice Address - Phone:212-234-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02967800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist