Provider Demographics
NPI:1114204179
Name:HASHEMI, GISOO (RPH)
Entity Type:Individual
Prefix:MRS
First Name:GISOO
Middle Name:
Last Name:HASHEMI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16230 WATERFRONT WAY
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63040-1514
Mailing Address - Country:US
Mailing Address - Phone:636-273-4629
Mailing Address - Fax:
Practice Address - Street 1:250 E 4TH ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-1953
Practice Address - Country:US
Practice Address - Phone:636-938-5635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002027556183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist