Provider Demographics
NPI:1508130337
Name:KASSA, KASSAHUN B
Entity Type:Individual
Prefix:
First Name:KASSAHUN
Middle Name:B
Last Name:KASSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3022 NE 140TH ST APT 106
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-3587
Mailing Address - Country:US
Mailing Address - Phone:206-588-1627
Mailing Address - Fax:
Practice Address - Street 1:12318 15TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4820
Practice Address - Country:US
Practice Address - Phone:206-306-0508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60209182183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist