Provider Demographics
NPI:1982309266
Name:GEYDAROVA, ELVIRA P
Entity Type:Individual
Prefix:
First Name:ELVIRA
Middle Name:P
Last Name:GEYDAROVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27129 122ND PL SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-5414
Mailing Address - Country:US
Mailing Address - Phone:425-240-9785
Mailing Address - Fax:
Practice Address - Street 1:10407 SE 256TH ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-6366
Practice Address - Country:US
Practice Address - Phone:253-854-5343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA60996135183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician