Provider Demographics
NPI:1083729032
Name:ALEXANDRIA DRUGS LLC
Entity Type:Organization
Organization Name:ALEXANDRIA DRUGS LLC
Other - Org Name:EASTERN'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELRAZZAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-304-9956
Mailing Address - Street 1:515 MINOR AVE
Mailing Address - Street 2:STE 120
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2120
Mailing Address - Country:US
Mailing Address - Phone:206-622-6094
Mailing Address - Fax:206-622-3667
Practice Address - Street 1:515 MINOR AVE
Practice Address - Street 2:STE 120
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2120
Practice Address - Country:US
Practice Address - Phone:206-622-6094
Practice Address - Fax:206-622-3667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WA604461803336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2036117Medicaid
2144607OtherPK
2108507OtherPK