Individual
BASAVA PURNA TIYYAGURA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8230 MARTIN WAY E, LACEY, WA 98516-5726
(360) 456-0444
Mailing address
8230 MARTIN WAY E, LACEY, WA 98516-5726
(360) 456-0444
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PH60210876
WA
Other
Enumeration date
11/27/2012
Last updated
11/27/2012
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