Provider Demographics
NPI:1316253248
Name:KOUSOUM, SONYA (PHARMD)
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:
Last Name:KOUSOUM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 SUMMIT AVE N
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-4714
Mailing Address - Country:US
Mailing Address - Phone:801-699-4019
Mailing Address - Fax:
Practice Address - Street 1:13023 GREENWOOD AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-7308
Practice Address - Country:US
Practice Address - Phone:206-365-4048
Practice Address - Fax:206-365-4096
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6092318-1701183500000X
WAPH60167788183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist