Provider Demographics
NPI:1184291528
Name:ELZEIBAK, HANAN (PTCB)
Entity type:Individual
Prefix:MRS
First Name:HANAN
Middle Name:
Last Name:ELZEIBAK
Suffix:
Gender:F
Credentials:PTCB
Other - Prefix:
Other - First Name:HANAN
Other - Middle Name:MOHAMED
Other - Last Name:ELZEIBAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13105 21ST DR SE APT J103
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-7182
Mailing Address - Country:US
Mailing Address - Phone:425-244-6160
Mailing Address - Fax:
Practice Address - Street 1:22833 BOTHELL EVERETT HWY
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-9385
Practice Address - Country:US
Practice Address - Phone:425-244-6160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician