Healthcare Provider Details

I. General information

NPI: 1861319428
Provider Name (Legal Business Name): SOCHEATA STADTHER
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5999 BURKE COMMONS RD
BURKE VA
22015-2880
US

IV. Provider business mailing address

4029 FORGE DR
WOODBRIDGE VA
22193-2215
US

V. Phone/Fax

Practice location:
  • Phone: 703-249-7943
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number0230012617
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: