Provider Demographics
NPI:1215044854
Name:SUTHAR, PARESH K (OWNER)
Entity Type:Individual
Prefix:MR
First Name:PARESH
Middle Name:K
Last Name:SUTHAR
Suffix:
Gender:M
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 MEMORIAL BLVD S
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-6417
Mailing Address - Country:US
Mailing Address - Phone:276-666-6614
Mailing Address - Fax:
Practice Address - Street 1:808 MEMORIAL BLVD S
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-6417
Practice Address - Country:US
Practice Address - Phone:276-666-6614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician