Provider Demographics
NPI:1962798157
Name:QAYOUM, ABDUL KHALEEL (PHARMD)
Entity type:Individual
Prefix:
First Name:ABDUL
Middle Name:KHALEEL
Last Name:QAYOUM
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 1:413 LILLY RD NE # LL-H10
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5133
Mailing Address - Country:US
Mailing Address - Phone:360-493-7412
Mailing Address - Fax:360-493-5403
Practice Address - Street 1:413 LILLY RD NE # LL-H10
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5133
Practice Address - Country:US
Practice Address - Phone:360-493-7412
Practice Address - Fax:360-493-5403
Is Sole Proprietor?:No
Enumeration Date:2011-06-25
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00067111183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist