Provider Demographics
NPI:1629592589
Name:ESTAWROW, RANDA RAAFAT RIAD (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:RANDA
Middle Name:RAAFAT RIAD
Last Name:ESTAWROW
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22626 NE INGELWOOD HILL RD APT 322
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-5006
Mailing Address - Country:US
Mailing Address - Phone:714-733-9380
Mailing Address - Fax:
Practice Address - Street 1:22626 NE INGELWOOD HILL RD APT 322
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-5006
Practice Address - Country:US
Practice Address - Phone:714-733-9380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60755523333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAESTAWRR148L7OtherWASHINGTON STATE