Provider Demographics
NPI:1669856621
Name:JHA, SUCHETA KARTIKEYA
Entity Type:Individual
Prefix:
First Name:SUCHETA
Middle Name:KARTIKEYA
Last Name:JHA
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 1:1618 N PICCADILLY LN
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-5047
Mailing Address - Country:US
Mailing Address - Phone:561-289-6612
Mailing Address - Fax:
Practice Address - Street 1:1618 N PICCADILLY LN
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-5047
Practice Address - Country:US
Practice Address - Phone:561-289-6612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-18
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69152183500000X
FL39946183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist