MEDICARE: BASEM ELSAYED RPH. LICENSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PH60482957	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PH60482957	OTHER	WA	PHARMACIST LICENSE

General Provider Information

NPI Number	:	1669856522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BASEM ELSAYED RPH. LICENSE

Provider Business Mailing Address
First Line	:	20721 OLYMPIC PL NE APT A112
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-4861
Country	:	US
Telephone Number	:	206-883-7171
Fax Number	:

Provider Business Practice Location Address
First Line	:	4010 172ND ST NE
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-8482
Country	:	US
Telephone Number	:	360-386-4608
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2015
Last Update Date	:	07/10/2015

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