Provider Demographics
NPI:1255618476
Name:SANAEI, FRED F (RPH)
Entity type:Individual
Prefix:MR
First Name:FRED
Middle Name:F
Last Name:SANAEI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15225 PACIFIC AVE
Mailing Address - Street 2:WALGREENS SPANAWAY
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444
Mailing Address - Country:US
Mailing Address - Phone:253-538-6916
Mailing Address - Fax:
Practice Address - Street 1:15225 PACIFIC AVE
Practice Address - Street 2:WALGREENS SPANAWAY
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444
Practice Address - Country:US
Practice Address - Phone:253-538-6916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00042848183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist