Healthcare Provider Details

I. General information

NPI: 1316253248
Provider Name (Legal Business Name): SONYA KOUSOUM PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13023 GREENWOOD AVE N
SEATTLE WA
98133-7308
US

IV. Provider business mailing address

304 SUMMIT AVE N
KENT WA
98030-4714
US

V. Phone/Fax

Practice location:
  • Phone: 206-365-4048
  • Fax: 206-365-4096
Mailing address:
  • Phone: 801-699-4019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6092318-1701
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60167788
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: