Provider Demographics
NPI:1679881650
Name:SUKHATANKAR, DEEPA S
Entity Type:Individual
Prefix:MS
First Name:DEEPA
Middle Name:S
Last Name:SUKHATANKAR
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 1:307 BUCKLAND MILLS CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-4284
Mailing Address - Country:US
Mailing Address - Phone:919-535-8058
Mailing Address - Fax:
Practice Address - Street 1:151 VILLAGE WALK DR
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-7680
Practice Address - Country:US
Practice Address - Phone:919-552-5378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16963183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist