Provider Demographics
NPI:1679027759
Name:FASANMI, ESTHER (PHARMD)
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:
Last Name:FASANMI
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 1:6061 MONTE VISTA LN
Mailing Address - Street 2:APT. 1015
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-5434
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1350 S MAIN ST
Practice Address - Street 2:SUITE 1600
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7611
Practice Address - Country:US
Practice Address - Phone:817-702-3701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-07
Last Update Date:2016-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX553661835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care