Provider Demographics
NPI:1205362340
Name:NAMATALLA, HEBATALLA (RPH)
Entity Type:Individual
Prefix:MISS
First Name:HEBATALLA
Middle Name:
Last Name:NAMATALLA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6007 244TH ST SW STE A2
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-5427
Mailing Address - Country:US
Mailing Address - Phone:425-356-3276
Mailing Address - Fax:
Practice Address - Street 1:6007 244TH ST SW STE A2
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-5427
Practice Address - Country:US
Practice Address - Phone:425-356-3276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00015640183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist