Active NPI
Pratap Suryadevara, PHARMACIST
- Pharmacist
- Everett, WA
National Provider Identifier
1972156669
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH61330362
- Practice address
- 6807 Evergreen Way
Everett, WA 98203-5145 - Phone
- (425) 438-9380
- NPI assigned
- Jul 22, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 17999 | NV | |
| Pharmacist | 183500000X | PH61330362 | WA | Primary |
Addresses
Primary practice location
6807 Evergreen Way
Everett, WA 98203-5145
Mailing address
4995 Kietzke LN
Reno, NV 89509-6548
Phone (775) 825-3322
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17999 | NV | MD | Pharmacist |
| PH61330362 | WA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1563753600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683849600000",
"number": "1972156669",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4995 KIETZKE LN",
"city": "RENO",
"state": "NV",
"postal_code": "895096548",
"telephone_number": "775-825-3322",
"fax_number": "775-827-4633"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6807 EVERGREEN WAY",
"city": "EVERETT",
"state": "WA",
"postal_code": "982035145",
"telephone_number": "425-438-9380"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SURYADEVARA",
"first_name": "PRATAP",
"name_prefix": "Mr.",
"credential": "PHARMACIST",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-07-22",
"last_updated": "2023-05-12",
"certification_date": "2023-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NV",
"license": "17999",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH61330362",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Everett, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.