Provider Demographics
NPI:1407157779
Name:SALEHI, HESSAMODDIN (RPH)
Entity Type:Individual
Prefix:
First Name:HESSAMODDIN
Middle Name:
Last Name:SALEHI
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 1:12519 NE 85TH ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-8048
Mailing Address - Country:US
Mailing Address - Phone:425-822-9235
Mailing Address - Fax:425-822-0538
Practice Address - Street 1:12519 NE 85TH ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-8048
Practice Address - Country:US
Practice Address - Phone:425-822-9235
Practice Address - Fax:425-822-0538
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00016915183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist