Provider Demographics
NPI:1346652435
Name:RASOULI OSKOUEI, AYLAR
Entity Type:Individual
Prefix:
First Name:AYLAR
Middle Name:
Last Name:RASOULI OSKOUEI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 221ST ST SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-8261
Mailing Address - Country:US
Mailing Address - Phone:425-381-7074
Mailing Address - Fax:
Practice Address - Street 1:20500 OLYMPIC PL NE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-5094
Practice Address - Country:US
Practice Address - Phone:360-403-3378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-23
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60412290183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist