Provider Demographics
NPI:1477204188
Name:SRISUTIVA, PARKIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:PARKIN
Middle Name:
Last Name:SRISUTIVA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 SE 29TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66605-2596
Mailing Address - Country:US
Mailing Address - Phone:785-267-0234
Mailing Address - Fax:
Practice Address - Street 1:2010 SE 29TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66605-2596
Practice Address - Country:US
Practice Address - Phone:785-267-0234
Practice Address - Fax:785-274-0221
Is Sole Proprietor?:No
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-1038001835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist