Healthcare Provider Details

I. General information

NPI: 1598370637
Provider Name (Legal Business Name): LIYA W TSEGAYE PH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4919 EVERGREEN WAY
EVERETT WA
98203-2828
US

IV. Provider business mailing address

912 N 96TH ST APT 226
SEATTLE WA
98103-3273
US

V. Phone/Fax

Practice location:
  • Phone: 425-259-3444
  • Fax:
Mailing address:
  • Phone: 206-446-5636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number61059281
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: