Provider Demographics
NPI:1063785012
Name:RAJAN, ALYKYHAN SADRUDIN (RPH)
Entity type:Individual
Prefix:
First Name:ALYKYHAN
Middle Name:SADRUDIN
Last Name:RAJAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18111 96TH AVE NE APT 203
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3352
Mailing Address - Country:US
Mailing Address - Phone:206-234-8433
Mailing Address - Fax:
Practice Address - Street 1:12906 BOTHELL EVERETT HWY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-6687
Practice Address - Country:US
Practice Address - Phone:425-357-2033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00041807183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist