Provider Demographics
NPI:1740510429
Name:OMER, FETIYA ABDO (PHARMD)
Entity type:Individual
Prefix:DR
First Name:FETIYA
Middle Name:ABDO
Last Name:OMER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5729 181ST PL SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-7312
Mailing Address - Country:US
Mailing Address - Phone:832-656-8258
Mailing Address - Fax:
Practice Address - Street 1:13110 BOTHELL EVERETT HWY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-7202
Practice Address - Country:US
Practice Address - Phone:425-379-7279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-03
Last Update Date:2010-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00057021183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH00057021OtherPHARMACIST LICENCE NUMBER