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General NPI Number Information
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NPI Number | 1972156669
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Entity Type | Individual
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Provider Name | PRATAP SURYADEVARA PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 07/22/2019
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Last Update Date | 05/12/2023
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Provider Practice Location Address
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Address Line | 6807 EVERGREEN WAY
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City | EVERETT
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State | WA
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Zip | 98203-5145
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Country | US
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Telephone | 425-438-9380
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Fax |
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Provider Business Mailing Address
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Address Line | 4995 KIETZKE LN
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City | RENO
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State | NV
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Zip | 89509-6548
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Country | US
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Telephone | 775-825-3322
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Fax | 775-827-4633
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 17999
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH61330362
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License Number State | WA
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