Provider Demographics
NPI:1669856522
Name:ELSAYED, BASEM (RPH LICENSE)
Entity type:Individual
Prefix:
First Name:BASEM
Middle Name:
Last Name:ELSAYED
Suffix:
Gender:M
Credentials:RPH LICENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20721 OLYMPIC PL NE APT A112
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-4861
Mailing Address - Country:US
Mailing Address - Phone:206-883-7171
Mailing Address - Fax:
Practice Address - Street 1:4010 172ND ST NE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8482
Practice Address - Country:US
Practice Address - Phone:360-386-4608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60482957183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH60482957OtherPHARMACIST LICENSE