Healthcare Provider Details

I. General information

NPI: 1922581784
Provider Name (Legal Business Name): NEDA NOURBAKHSH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

325 9TH AVENUE ADULT MEDICINE CLINIC
SEATTLE WA
98104
US

IV. Provider business mailing address

309 16TH AVE E APT 103
SEATTLE WA
98112-5141
US

V. Phone/Fax

Practice location:
  • Phone: 801-744-2163
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPH60758309
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: