MEDICARE: HASSANA IREDIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PH60001494	WA

General Provider Information

NPI Number	:	1376835702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HASSANA IREDIA

Provider Business Mailing Address
First Line	:	9404 FAGAN CT NE
Second Line	:
City	:	LACEY
State	:	WA
Zip	:	98516-6600
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 COOPER POINT RD NW
Second Line	:	SUITE 105
City	:	OLYMPIA
State	:	WA
Zip	:	98502-4436
Country	:	US
Telephone Number	:	360-754-8014
Fax Number	:	360-754-0778

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2011
Last Update Date	:	05/03/2011

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Directions to “ HASSANA IREDIA ” Practice Location

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