Provider Demographics
NPI:1922496553
Name:PAKTIA PHARMACY LLC
Entity Type:Organization
Organization Name:PAKTIA PHARMACY LLC
Other - Org Name:PAKTIA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:RASHID
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMALI
Authorized Official - Suffix:
Authorized Official - Credentials:PH60008825
Authorized Official - Phone:425-409-7309
Mailing Address - Street 1:315 5TH AVE S UNIT C
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-3600
Mailing Address - Country:US
Mailing Address - Phone:425-967-5375
Mailing Address - Fax:425-967-3415
Practice Address - Street 1:315 5TH AVE S UNIT #C
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020
Practice Address - Country:US
Practice Address - Phone:425-967-5375
Practice Address - Fax:425-967-3415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60512097333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy