Healthcare Provider Details

I. General information

NPI: 1134126311
Provider Name (Legal Business Name): SUDHA NARAYANASWAMY PHARM.D., BCPP, CGP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 SCHENECTADY AVE
BROOKLYN NY
11203-1809
US

IV. Provider business mailing address

5 DEMSEY CT
JERSEY CITY NJ
07305-5506
US

V. Phone/Fax

Practice location:
  • Phone: 718-604-5342
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number047757
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: