Provider Demographics
NPI:1811494255
Name:TADROS, MINA MICHEL ISHAK (RPH)
Entity type:Individual
Prefix:
First Name:MINA
Middle Name:MICHEL ISHAK
Last Name:TADROS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 NW AMBERCREST WAY APT 206
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-7788
Mailing Address - Country:US
Mailing Address - Phone:407-777-1845
Mailing Address - Fax:
Practice Address - Street 1:27000 MILLER BAY RD NE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:WA
Practice Address - Zip Code:98346-9371
Practice Address - Country:US
Practice Address - Phone:360-297-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2019-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60805847183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist