Provider Demographics
NPI:1053052001
Name:METHRATTA, SAM (PHARMD)
Entity type:Individual
Prefix:MR
First Name:SAM
Middle Name:
Last Name:METHRATTA
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BELGRADE AVE
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-3006
Mailing Address - Country:US
Mailing Address - Phone:617-363-1726
Mailing Address - Fax:
Practice Address - Street 1:30 BELGRADE AVE
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-3006
Practice Address - Country:US
Practice Address - Phone:617-363-1726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53025183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist