Suja Thannickal, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

28RI02242300 Issued in NJ

Practice address

20 S Kinderkamack Rd
Montvale, NJ 07645-2166

Phone

(201) 930-9010

Fax

(201) 802-1891

NPI assigned

Nov 19, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1605744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605744000000",
    "number": "1346843612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 S KINDERKAMACK RD",
            "city": "MONTVALE",
            "state": "NJ",
            "postal_code": "076452166",
            "telephone_number": "201-930-9010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 S KINDERKAMACK RD",
            "city": "MONTVALE",
            "state": "NJ",
            "postal_code": "076452166",
            "telephone_number": "201-930-9010",
            "fax_number": "201-802-1891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THANNICKAL",
        "first_name": "SUJA",
        "name_prefix": "Mrs.",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-11-19",
        "last_updated": "2020-11-19",
        "certification_date": "2020-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NJ",
            "license": "28RI02242300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Montvale",
            "affiliation": "N",
            "address_1": "20 S Kinderkamack Rd",
            "city": "Montvale",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "076452166",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Montvale",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "20 S Kinderkamack Rd",
            "city": "Montvale",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "076452166",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Pharmacist in Montvale, NJ
• Providers in Montvale, NJ by specialty
• Pharmacist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.