=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134126311
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUDHA NARAYANASWAMY PHARM.D., BCPP, CGP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2005
-----------------------------------------------------
Last Update Date | 12/12/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 585 SCHENECTADY AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11203-1809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-604-5342
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 DEMSEY CT
-----------------------------------------------------
City | JERSEY CITY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07305-5506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P1300X
-----------------------------------------------------
Taxonomy Name | Psychiatric Pharmacist
-----------------------------------------------------
License Number | 047757
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------