Provider Demographics
NPI:1689047417
Name:SITAPARA, RAJ
Entity Type:Individual
Prefix:
First Name:RAJ
Middle Name:
Last Name:SITAPARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8230 MARTIN WAY E
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-5726
Mailing Address - Country:US
Mailing Address - Phone:360-456-0444
Mailing Address - Fax:360-456-1101
Practice Address - Street 1:8230 MARTIN WAY E
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-5726
Practice Address - Country:US
Practice Address - Phone:360-456-0444
Practice Address - Fax:360-456-1101
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 60595571183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist