Provider Demographics
NPI:1306271861
Name:TESARIK, GEOFF (RPH)
Entity type:Individual
Prefix:
First Name:GEOFF
Middle Name:
Last Name:TESARIK
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 1:210 E NORTH FOOTHILLS DR
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-2155
Mailing Address - Country:US
Mailing Address - Phone:509-325-6933
Mailing Address - Fax:509-326-7176
Practice Address - Street 1:210 E NORTH FOOTHILLS DR
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-2155
Practice Address - Country:US
Practice Address - Phone:509-325-6933
Practice Address - Fax:509-326-7176
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00018275183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6014013Medicaid