Provider Demographics
NPI:1972728111
Name:SASSE, DAWN MICHELLE (RPH)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MICHELLE
Last Name:SASSE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:MICHELLE
Other - Last Name:FISCHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:19708 SE 30TH WAY
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-9441
Mailing Address - Country:US
Mailing Address - Phone:360-798-6775
Mailing Address - Fax:
Practice Address - Street 1:13511 SE 3RD WAY
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6990
Practice Address - Country:US
Practice Address - Phone:360-885-0839
Practice Address - Fax:360-885-0843
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00017118183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist