Healthcare Provider Details

I. General information

NPI: 1306762885
Provider Name (Legal Business Name): JENNIFER JULIA NIYAZOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9999 HOLMAN RD NW
SEATTLE WA
98117-2041
US

IV. Provider business mailing address

17610 DAYTON AVE N
SHORELINE WA
98133-4715
US

V. Phone/Fax

Practice location:
  • Phone: 206-782-4100
  • Fax:
Mailing address:
  • Phone: 206-661-4580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPHRM.PH.70013529
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: