Provider Demographics
NPI:1255762159
Name:DEVARAJAN, APARNA
Entity type:Individual
Prefix:MISS
First Name:APARNA
Middle Name:
Last Name:DEVARAJAN
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 1:23128 SE 27TH WAY
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-9495
Mailing Address - Country:US
Mailing Address - Phone:214-634-7466
Mailing Address - Fax:
Practice Address - Street 1:10625 NE 68TH ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-7054
Practice Address - Country:US
Practice Address - Phone:425-822-2241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 60394159183500000X
TX46036183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist