Provider Demographics
NPI:1265575773
Name:B.M.D CORPORATION
Entity type:Organization
Organization Name:B.M.D CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SOHRAB
Authorized Official - Middle Name:
Authorized Official - Last Name:DANESHFAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:425-771-8090
Mailing Address - Street 1:3005 ALDERWOOD MALL PKWY
Mailing Address - Street 2:SUITE # 100
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036
Mailing Address - Country:US
Mailing Address - Phone:425-771-8090
Mailing Address - Fax:
Practice Address - Street 1:3005 ALDERWOOD MALL PKWY
Practice Address - Street 2:SUITE # 100
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6920
Practice Address - Country:US
Practice Address - Phone:425-771-8090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF580653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6028260Medicaid
WA5498800001Medicare NSC