MEDICARE: KAREN C SUNDERRAJ PHARM D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	061520	NY
2	183500000X	Pharmacist	PH236462	MA

General Provider Information

NPI Number	:	1053773192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN C SUNDERRAJ PHARM D

Provider Business Mailing Address
First Line	:	80 E 116TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-1128
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 E 116TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-1128
Country	:	US
Telephone Number	:	212-348-7788
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2016
Last Update Date	:	03/28/2016

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