Provider Demographics
NPI:1174089387
Name:BASSYOUNI, AHMED (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AHMED
Middle Name:
Last Name:BASSYOUNI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 N WEST AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-1251
Mailing Address - Country:US
Mailing Address - Phone:360-435-5771
Mailing Address - Fax:360-435-2155
Practice Address - Street 1:540 N WEST AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-1251
Practice Address - Country:US
Practice Address - Phone:360-435-5771
Practice Address - Fax:360-435-2155
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-12
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60961847183500000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2143263Medicaid