Provider Demographics
NPI:1285806232
Name:MATHUR, SRUTI (PHARMACIST)
Entity type:Individual
Prefix:
First Name:SRUTI
Middle Name:
Last Name:MATHUR
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 HARMON PL
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-2803
Mailing Address - Country:US
Mailing Address - Phone:845-323-4350
Mailing Address - Fax:
Practice Address - Street 1:15 S ROUTE 303
Practice Address - Street 2:
Practice Address - City:CONGERS
Practice Address - State:NY
Practice Address - Zip Code:10920-2449
Practice Address - Country:US
Practice Address - Phone:845-267-5945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY51477183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY051477OtherSTATE BOARD OF PHARMACY