Provider Demographics
NPI:1174894117
Name:CHMAIT, TARIK
Entity type:Individual
Prefix:MR
First Name:TARIK
Middle Name:
Last Name:CHMAIT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 E FOURTH PLAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-6584
Mailing Address - Country:US
Mailing Address - Phone:360-693-5030
Mailing Address - Fax:360-693-6936
Practice Address - Street 1:5000 E FOURTH PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-6584
Practice Address - Country:US
Practice Address - Phone:360-693-5030
Practice Address - Fax:360-693-6936
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00056975183500000X
OR0010968183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist