Provider Demographics
NPI:1497164420
Name:ESHETU, SEIFU A (RPH)
Entity Type:Individual
Prefix:
First Name:SEIFU
Middle Name:A
Last Name:ESHETU
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 1:17222 HIGHWAY 99
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-3170
Mailing Address - Country:US
Mailing Address - Phone:425-245-1713
Mailing Address - Fax:425-245-1713
Practice Address - Street 1:17222 HIGHWAY 99
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-3170
Practice Address - Country:US
Practice Address - Phone:425-245-1713
Practice Address - Fax:425-245-1713
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00042724183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist