Provider Demographics
NPI:1386938330
Name:DASHTESTANI, FATEMEH GIZELLE (PHARM-D, RPH)
Entity type:Individual
Prefix:DR
First Name:FATEMEH
Middle Name:GIZELLE
Last Name:DASHTESTANI
Suffix:
Gender:F
Credentials:PHARM-D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12421 TOTEM LAKE BLVD NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-7504
Mailing Address - Country:US
Mailing Address - Phone:425-821-1500
Mailing Address - Fax:425-823-0801
Practice Address - Street 1:12421 TOTEM LAKE BLVD NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7504
Practice Address - Country:US
Practice Address - Phone:425-821-1500
Practice Address - Fax:425-823-0801
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00021301183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6018147Medicaid
WA4921789OtherNABP
WA4921789OtherNABP