Provider Demographics
NPI:1053673715
Name:HAILESELASSIE, ZEREIT (RPH)
Entity Type:Individual
Prefix:MR
First Name:ZEREIT
Middle Name:
Last Name:HAILESELASSIE
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 1:1001 MADISON ST STE 150
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1993
Mailing Address - Country:US
Mailing Address - Phone:800-619-7610
Mailing Address - Fax:800-619-7611
Practice Address - Street 1:1001 MADISON ST STE 150
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1993
Practice Address - Country:US
Practice Address - Phone:800-619-7610
Practice Address - Fax:800-619-7611
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00015709183500000X, 1835P0018X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy