Provider Demographics
NPI:1144747510
Name:AJENAH, MOHAMED K K (PH60641602)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:K K
Last Name:AJENAH
Suffix:
Gender:M
Credentials:PH60641602
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9520 NE 120TH ST APT A206
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-8916
Mailing Address - Country:US
Mailing Address - Phone:206-446-3501
Mailing Address - Fax:
Practice Address - Street 1:7315 212TH ST SW # ATE100
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7610
Practice Address - Country:US
Practice Address - Phone:425-778-7778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-27
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60641602183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist