MEDICARE: OSSY SUTJITA

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	S024907	AZ

General Provider Information

NPI Number	:	1962008052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OSSY SUTJITA

Provider Business Mailing Address
First Line	:	7701 W SAINT JOHN RD APT 2078
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-8632
Country	:	US
Telephone Number	:	951-231-8202
Fax Number	:

Provider Business Practice Location Address
First Line	:	1616 E THOMAS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-7602
Country	:	US
Telephone Number	:	22-638-3076
Fax Number	:

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

Provider Enumeration Date	:	12/05/2020
Last Update Date	:	04/18/2023

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Directions to “ OSSY SUTJITA ” Practice Location

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