Healthcare Provider Details

I. General information

NPI: 1114091238
Provider Name (Legal Business Name): SHYAMAL K SARKAR RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 PINE GLEN DR
BLAUVELT NY
10913-1150
US

IV. Provider business mailing address

7 PINE GLEN DR
BLAUVELT NY
10913-1150
US

V. Phone/Fax

Practice location:
  • Phone: 845-353-3818
  • Fax:
Mailing address:
  • Phone: 845-353-3818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number034253
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: