Provider Demographics
NPI:1790557346
Name:THYAGARAJ, SNIGDA (PHARMD)
Entity type:Individual
Prefix:
First Name:SNIGDA
Middle Name:
Last Name:THYAGARAJ
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 741515
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-1515
Mailing Address - Country:US
Mailing Address - Phone:425-775-9474
Mailing Address - Fax:425-670-3554
Practice Address - Street 1:7315 212TH ST SW
Practice Address - Street 2:STE 101/207
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7610
Practice Address - Country:US
Practice Address - Phone:425-775-9474
Practice Address - Fax:425-670-3554
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0024634183500000X
WAPH615681371835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist