Provider Demographics
NPI:1073765624
Name:PRABHU, GIREESHA (RPH)
Entity Type:Individual
Prefix:MR
First Name:GIREESHA
Middle Name:
Last Name:PRABHU
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 1:1225 E SUNSET DR
Mailing Address - Street 2:STE 110
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-3597
Mailing Address - Country:US
Mailing Address - Phone:360-671-5041
Mailing Address - Fax:360-676-1626
Practice Address - Street 1:1225 E SUNSET DR
Practice Address - Street 2:STE 110
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-3597
Practice Address - Country:US
Practice Address - Phone:360-671-5041
Practice Address - Fax:360-676-1626
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00059131183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist