Provider Demographics
NPI:1104187301
Name:SUTHAR, SUCHETA
Entity Type:Individual
Prefix:
First Name:SUCHETA
Middle Name:
Last Name:SUTHAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22828 100TH AVE W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-5920
Mailing Address - Country:US
Mailing Address - Phone:425-778-2144
Mailing Address - Fax:425-771-5420
Practice Address - Street 1:22828 100TH AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-5920
Practice Address - Country:US
Practice Address - Phone:425-778-2144
Practice Address - Fax:425-771-5420
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA69398183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA910849764Medicaid