Provider Demographics
NPI:1104152396
Name:FASIHI, IREM SHAH (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:IREM
Middle Name:SHAH
Last Name:FASIHI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 ARMY PENTAGON
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20310-5801
Mailing Address - Country:US
Mailing Address - Phone:703-692-8771
Mailing Address - Fax:
Practice Address - Street 1:5801 ARMY PENTAGON
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20310-5801
Practice Address - Country:US
Practice Address - Phone:703-692-8771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020333501835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist