Healthcare Provider Details

I. General information

NPI: 1750367892
Provider Name (Legal Business Name): SHELBY J SUHADOLNIK PHT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6619 132ND AVE NE
KIRKLAND WA
98033-8627
US

IV. Provider business mailing address

7503 130TH AVE NE
KIRKLAND WA
98033-8246
US

V. Phone/Fax

Practice location:
  • Phone: 425-881-5544
  • Fax:
Mailing address:
  • Phone: 425-827-4737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA00016565
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: