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General NPI Number Information
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NPI Number | 1528421088
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Entity Type | Individual
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Provider Name | MUSTAFA LUTFI M SOWAN PH
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Gender | Male
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Dates
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Enumeration Date | 04/01/2016
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Last Update Date | 08/31/2016
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Provider Practice Location Address
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Address Line | 4714 212TH ST SW APT 201
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City | MOUNTLAKE TERRACE
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State | WA
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Zip | 98043-5911
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Country | US
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Telephone | 619-313-1945
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Fax |
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Provider Business Mailing Address
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Address Line | 1304 BRUSKRUD RD APT E206
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City | EVERETT
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State | WA
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Zip | 98208-4100
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Country | US
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Telephone | 619-313-1945
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH60612464
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License Number State | WA
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