Provider Demographics
NPI:1275089229
Name:ALEXANDRIA DRUGS LLC
Entity Type:Organization
Organization Name:ALEXANDRIA DRUGS LLC
Other - Org Name:SENIOR CARE GLOBAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC
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:206-622-6094
Mailing Address - Street 1:25680 104TH AVE SE
Mailing Address - Street 2:ROOM 1
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-7610
Mailing Address - Country:US
Mailing Address - Phone:253-236-4073
Mailing Address - Fax:253-243-7943
Practice Address - Street 1:25680 104TH AVE SE
Practice Address - Street 2:ROOM 1
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-7610
Practice Address - Country:US
Practice Address - Phone:253-236-4073
Practice Address - Fax:253-243-7943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-30
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WACF.606790693336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159068OtherPK
WA2074369Medicaid