Provider Demographics
NPI:1306099395
Name:ALI, SYED M (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SYED
Middle Name:M
Last Name:ALI
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 1:2519 MAIN STREET
Mailing Address - Street 2:RITE AID PHARMACY
Mailing Address - City:UNION GAP
Mailing Address - State:WA
Mailing Address - Zip Code:98903
Mailing Address - Country:US
Mailing Address - Phone:509-453-3603
Mailing Address - Fax:509-248-2875
Practice Address - Street 1:2519 MAIN STREET
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:UNION GAP
Practice Address - State:WA
Practice Address - Zip Code:98903
Practice Address - Country:US
Practice Address - Phone:509-453-3603
Practice Address - Fax:509-248-2875
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00021116183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist