Provider Demographics
NPI:1598370637
Name:TSEGAYE, LIYA W (PH)
Entity Type:Individual
Prefix:
First Name:LIYA
Middle Name:W
Last Name:TSEGAYE
Suffix:
Gender:F
Credentials:PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 N 96TH ST APT 226
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-3273
Mailing Address - Country:US
Mailing Address - Phone:206-446-5636
Mailing Address - Fax:
Practice Address - Street 1:4412 RAINIER AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-1373
Practice Address - Country:US
Practice Address - Phone:206-760-7880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61059281183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist