Provider Demographics
NPI:1528350121
Name:YESHITLA, BEZANESH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BEZANESH
Middle Name:
Last Name:YESHITLA
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 1:1631 KALORAMA RD NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-3545
Mailing Address - Country:US
Mailing Address - Phone:202-299-1874
Mailing Address - Fax:202-986-3860
Practice Address - Street 1:1631 KALORAMA RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-3545
Practice Address - Country:US
Practice Address - Phone:202-299-1874
Practice Address - Fax:202-986-3860
Is Sole Proprietor?:No
Enumeration Date:2011-05-14
Last Update Date:2011-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH100000695183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist