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NPI Code Detail

MEDICARE: HEENA SUDRA PHARM.D

MEDICARE: HEENA SUDRA PHARM.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistRPH 67985CA

General Provider Information

NPI Number : 1124365119
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEENA SUDRA PHARM.D
Provider Business Mailing Address
First Line : 14735 WYANDOTTE ST
Second Line :
City : VAN NUYS
State : CA
Zip : 91405-1822
Country : US
Telephone Number : 818-430-9142
Fax Number :
Provider Business Practice Location Address
First Line : 7299 LAGUNA BLVD
Second Line :
City : ELK GROVE
State : CA
Zip : 95758-5059
Country : US
Telephone Number : 916-691-4412
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2013
Last Update Date : 01/10/2013

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Directions to “ HEENA SUDRA PHARM.D” Practice Location

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