Healthcare Provider Details

I. General information

NPI: 1689538621
Provider Name (Legal Business Name): HANEEN MAHMOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2539 MARVIN RD NE
LACEY WA
98516-3177
US

IV. Provider business mailing address

21800 PACIFIC HWY S APT G208
DES MOINES WA
98198-7790
US

V. Phone/Fax

Practice location:
  • Phone: 360-438-3072
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH70013682
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: