Healthcare Provider Details

I. General information

NPI: 1942742580
Provider Name (Legal Business Name): RAMY GEWIDA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 MARKET PL
LAKE STEVENS WA
98258-7949
US

IV. Provider business mailing address

9601 MARKET PL
LAKE STEVENS WA
98258-7949
US

V. Phone/Fax

Practice location:
  • Phone: 425-397-8944
  • Fax:
Mailing address:
  • Phone: 425-397-8944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number60602884
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60968583
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: