Provider Demographics
NPI:1245647585
Name:SANT, SAHRAH YESMYNE
Entity type:Individual
Prefix:
First Name:SAHRAH
Middle Name:YESMYNE
Last Name:SANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAHRAH
Other - Middle Name:YESMYNE
Other - Last Name:SAYYAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3201 NW RANDALL WAY
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-7952
Mailing Address - Country:US
Mailing Address - Phone:360-692-3966
Mailing Address - Fax:
Practice Address - Street 1:3201 NW RANDALL WAY
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7952
Practice Address - Country:US
Practice Address - Phone:360-692-3966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIR60180061183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist