Individual
GINA SUTEDJA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
200 WEST HOSPITAL DRIVE, WHITERIVER, AZ 85941
(928) 338-3502
Mailing address
PO BOX 860, WHITERIVER, AZ 85941-0860
(928) 338-3502
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PHA.0020505
CO
Other
Enumeration date
11/25/2014
Last updated
11/25/2014
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