Provider Demographics
NPI:1487269262
Name:SURE, PRADEEP KUMAR
Entity type:Individual
Prefix:
First Name:PRADEEP KUMAR
Middle Name:
Last Name:SURE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 W TABOR RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-3038
Mailing Address - Country:US
Mailing Address - Phone:913-223-0517
Mailing Address - Fax:
Practice Address - Street 1:1335 W TABOR RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3038
Practice Address - Country:US
Practice Address - Phone:913-223-0517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP454892183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist