Provider Demographics
NPI:1457755233
Name:VEDULA, SARADHA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SARADHA
Middle Name:
Last Name:VEDULA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17641 GARDEN WAY NE
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-3535
Mailing Address - Country:US
Mailing Address - Phone:425-398-6710
Mailing Address - Fax:425-398-6728
Practice Address - Street 1:17641 GARDEN WAY NE
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-3535
Practice Address - Country:US
Practice Address - Phone:425-398-6710
Practice Address - Fax:425-398-6728
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00059324183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH00059324OtherPHARMACIST