Provider Demographics
NPI:1457840274
Name:BASMEH, KHALIL NASSER (PHARMD)
Entity Type:Individual
Prefix:
First Name:KHALIL
Middle Name:NASSER
Last Name:BASMEH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 FRIEDLINE RD
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-8756
Mailing Address - Country:US
Mailing Address - Phone:509-969-2418
Mailing Address - Fax:
Practice Address - Street 1:6600 W NOB HILL BLVD
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-1976
Practice Address - Country:US
Practice Address - Phone:509-966-3814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60658879183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist