Provider Demographics
NPI:1821318965
Name:BASSIOUNI, MOHAMED (RPH)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:
Last Name:BASSIOUNI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 N PEARL ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2457
Mailing Address - Country:US
Mailing Address - Phone:253-879-0140
Mailing Address - Fax:253-879-0273
Practice Address - Street 1:1912 N PEARL ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2457
Practice Address - Country:US
Practice Address - Phone:253-879-0140
Practice Address - Fax:253-879-0273
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00065610183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist