Provider Demographics
NPI:1346507753
Name:AYYALA, SUBHADRA
Entity type:Individual
Prefix:
First Name:SUBHADRA
Middle Name:
Last Name:AYYALA
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 1:1611 8TH AVE N
Mailing Address - Street 2:#709
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-6234
Mailing Address - Country:US
Mailing Address - Phone:425-835-3693
Mailing Address - Fax:
Practice Address - Street 1:1611 8TH AVE N
Practice Address - Street 2:#709
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-6234
Practice Address - Country:US
Practice Address - Phone:425-835-3693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60267743183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist