Healthcare Provider Details

I. General information

NPI: 1417733023
Provider Name (Legal Business Name): HABIBO A SALAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3116 NE SUNSET BLVD
RENTON WA
98056-3337
US

IV. Provider business mailing address

17610 134TH LN SE
RENTON WA
98058-6817
US

V. Phone/Fax

Practice location:
  • Phone: 425-793-0787
  • Fax:
Mailing address:
  • Phone: 707-322-5915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH61278430
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: