Provider Demographics
NPI:1508150392
Name:NUTHAKKI, PADMA
Entity Type:Individual
Prefix:MS
First Name:PADMA
Middle Name:
Last Name:NUTHAKKI
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 1:17700 NE 76TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3300
Mailing Address - Country:US
Mailing Address - Phone:425-202-1000
Mailing Address - Fax:
Practice Address - Street 1:17700 NE 76TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3300
Practice Address - Country:US
Practice Address - Phone:425-202-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00072061183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist