Provider Demographics
NPI:1851877997
Name:IJAZ, KANZA
Entity Type:Individual
Prefix:
First Name:KANZA
Middle Name:
Last Name:IJAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 ONYX ST SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-2784
Mailing Address - Country:US
Mailing Address - Phone:610-741-7979
Mailing Address - Fax:
Practice Address - Street 1:305 COOPER POINT RD NW STE 103
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4436
Practice Address - Country:US
Practice Address - Phone:360-754-8014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60718772183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist