Healthcare Provider Details

I. General information

NPI: 1184291528
Provider Name (Legal Business Name): HANAN ELZEIBAK PTCB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANAN MOHAMED ELZEIBAK

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22833 BOTHELL EVERETT HWY
BOTHELL WA
98021-9385
US

IV. Provider business mailing address

13105 21ST DR SE APT J103
EVERETT WA
98208-7182
US

V. Phone/Fax

Practice location:
  • Phone: 425-244-6160
  • Fax:
Mailing address:
  • Phone: 425-244-6160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: