Healthcare Provider Details

I. General information

NPI: 1326470113
Provider Name (Legal Business Name): SHABANA MAHABUBA ALAM PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 DELRIDGE WAY SW STE 400
SEATTLE WA
98106-1273
US

IV. Provider business mailing address

11306 183RD PL NE #1019
REDMOND WA
98052-7261
US

V. Phone/Fax

Practice location:
  • Phone: 425-883-9532
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60287725
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: