Provider Demographics
NPI:1992227276
Name:BELAY, SAMUEL MULUGETA (PHARMACIST)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:MULUGETA
Last Name:BELAY
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31500 1ST AVE S APT 19-103
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5272
Mailing Address - Country:US
Mailing Address - Phone:206-787-2347
Mailing Address - Fax:
Practice Address - Street 1:4840 BORGEN BLVD NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-6826
Practice Address - Country:US
Practice Address - Phone:253-853-9340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-08
Last Update Date:2017-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60748075183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH60748075OtherPHARMACIST