Provider Demographics
NPI:1770877649
Name:TABATABAIE, NASRIN A
Entity type:Individual
Prefix:MS
First Name:NASRIN
Middle Name:A
Last Name:TABATABAIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 HARRISON AVE NW
Mailing Address - Street 2:TARGET0607
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-2566
Mailing Address - Country:US
Mailing Address - Phone:360-570-4617
Mailing Address - Fax:
Practice Address - Street 1:2925 HARRISON AVE NW
Practice Address - Street 2:TARGET0607
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-2566
Practice Address - Country:US
Practice Address - Phone:360-570-4617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00016238183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist