Provider Demographics
NPI:1740525369
Name:ACTIS, TESS MEILAN NISHIDA (PHARMD)
Entity type:Individual
Prefix:
First Name:TESS
Middle Name:MEILAN NISHIDA
Last Name:ACTIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:TESS
Other - Middle Name:MEILAN
Other - Last Name:NISHIDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2800 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-6930
Mailing Address - Country:US
Mailing Address - Phone:360-788-8610
Mailing Address - Fax:360-788-8611
Practice Address - Street 1:3301 SQUALICUM PKWY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225
Practice Address - Country:US
Practice Address - Phone:360-788-8610
Practice Address - Fax:360-788-8611
Is Sole Proprietor?:No
Enumeration Date:2012-12-07
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60147028183500000X, 1835P0018X
ORRPH-0012370183500000X
WA31111351835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy