Provider Demographics
NPI:1891025177
Name:JALALYAR, HEDAYATULLAH (RPH)
Entity type:Individual
Prefix:
First Name:HEDAYATULLAH
Middle Name:
Last Name:JALALYAR
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:PO BOX 4218
Mailing Address - Street 2:
Mailing Address - City:WEST RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99353
Mailing Address - Country:US
Mailing Address - Phone:509-967-5037
Mailing Address - Fax:
Practice Address - Street 1:585 GAGE BLVD
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-7761
Practice Address - Country:US
Practice Address - Phone:509-967-5037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH000218051835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1970Medicaid
1970Medicare PIN
WA1970Medicare UPIN
WA1970Medicare PIN
1970Medicare UPIN