Provider Demographics
NPI:1669525853
Name:KUMAR, SUDHA (RPH, MS)
Entity type:Individual
Prefix:MRS
First Name:SUDHA
Middle Name:
Last Name:KUMAR
Suffix:
Gender:F
Credentials:RPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 STORY ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-3530
Mailing Address - Country:US
Mailing Address - Phone:515-432-4093
Mailing Address - Fax:515-432-4147
Practice Address - Street 1:310 STORY ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-3530
Practice Address - Country:US
Practice Address - Phone:515-432-4093
Practice Address - Fax:515-432-4147
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist