Provider Demographics
NPI:1225035728
Name:JESTRAB, FREDERICK STEVEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:STEVEN
Last Name:JESTRAB
Suffix:
Gender:M
Credentials:RPH
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Mailing Address - Street 1:3119 OLYMPIC BLVD W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-1605
Mailing Address - Country:US
Mailing Address - Phone:253-566-6621
Mailing Address - Fax:253-756-2707
Practice Address - Street 1:9601 STEILACOOM BLVD SW
Practice Address - Street 2:WESTERN STATE HOSPITAL- MAIL STOP 13-100
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98498-7213
Practice Address - Country:US
Practice Address - Phone:253-756-2521
Practice Address - Fax:253-756-2707
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPH000103221835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric