Provider Demographics
NPI:1255622718
Name:KHALIFA, AHMED
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:KHALIFA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33636 25TH PL SW APT E4
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-7776
Mailing Address - Country:US
Mailing Address - Phone:347-791-2843
Mailing Address - Fax:
Practice Address - Street 1:2131 SW 336TH ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-2847
Practice Address - Country:US
Practice Address - Phone:253-952-2803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60172173183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist