Provider Demographics
NPI:1598368623
Name:HAILE, SURAFEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:SURAFEL
Middle Name:
Last Name:HAILE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22834 30TH AVE S APT 104
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-7224
Mailing Address - Country:US
Mailing Address - Phone:206-832-5717
Mailing Address - Fax:
Practice Address - Street 1:14901 4TH AVE SW STE 100
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-1906
Practice Address - Country:US
Practice Address - Phone:206-242-1201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61074529183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist