Provider Demographics
NPI:1518678150
Name:AHMADI, ABDULALI (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ABDULALI
Middle Name:
Last Name:AHMADI
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22603 56TH AVE W
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-3917
Mailing Address - Country:US
Mailing Address - Phone:206-612-5192
Mailing Address - Fax:
Practice Address - Street 1:7500 196TH ST SW STE A
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5090
Practice Address - Country:US
Practice Address - Phone:425-774-6669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61311778183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist