Provider Demographics
NPI:1093349086
Name:HUSSIEN, ALYAA S (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ALYAA
Middle Name:S
Last Name:HUSSIEN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22526 SE 4TH ST UNIT 526
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-5057
Mailing Address - Country:US
Mailing Address - Phone:469-554-2739
Mailing Address - Fax:
Practice Address - Street 1:22526 SE 4TH ST UNIT 526
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-5057
Practice Address - Country:US
Practice Address - Phone:469-554-2739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61011586183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1234Medicaid