Provider Demographics
NPI:1174803407
Name:PRADHAN, SALIM (RPH)
Entity type:Individual
Prefix:MR
First Name:SALIM
Middle Name:
Last Name:PRADHAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 CRYSTAL COURT
Mailing Address - Street 2:
Mailing Address - City:COQUITLAM
Mailing Address - State:BC
Mailing Address - Zip Code:V3C5X5
Mailing Address - Country:CA
Mailing Address - Phone:604-469-4435
Mailing Address - Fax:604-469-4436
Practice Address - Street 1:851 MOORE ST
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-1238
Practice Address - Country:US
Practice Address - Phone:360-856-2153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60106742183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist