Healthcare Provider Details

I. General information

NPI: 1942709795
Provider Name (Legal Business Name): ABDIKADIR ATHUR RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2018
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15320 33RD AVE S STE 222
SEATAC WA
98188-5114
US

IV. Provider business mailing address

15320 33RD AVE S UNIT 222
SEATAC WA
98188-5114
US

V. Phone/Fax

Practice location:
  • Phone: 206-388-3807
  • Fax: 206-388-3809
Mailing address:
  • Phone: 206-388-3807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number60800944
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: