Provider Demographics
NPI:1609124973
Name:POURMANDI, HORIEH (PHARMD)
Entity Type:Individual
Prefix:
First Name:HORIEH
Middle Name:
Last Name:POURMANDI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15515 JUANITA WOODINVILLE WAY NE APT C101
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-1582
Mailing Address - Country:US
Mailing Address - Phone:734-644-0340
Mailing Address - Fax:
Practice Address - Street 1:5217 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1209
Practice Address - Country:US
Practice Address - Phone:206-937-2191
Practice Address - Fax:206-937-2936
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60266579183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH60266579OtherPHARMACIST LICENSE