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NPI Code Detail

MEDICARE: DR. WILLIAM EDMOND FASSETT BS PHARM, MBA, PHD

MEDICARE: DR. WILLIAM EDMOND FASSETT BS PHARM, MBA, PHD
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
1183500000XPharmacistPH00008093WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PHCT.PH.60125044OTHERWAWASHINGTON COLLABORATIVE PRACTICE AGREEMENT

General Provider Information

NPI Number : 1548258114
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WILLIAM EDMOND FASSETT BS PHARM, MBA, PHD
Provider Business Mailing Address
First Line : 2403 W CAROLINA CT
Second Line :
City : SPOKANE
State : WA
Zip : 99208-8690
Country : US
Telephone Number : 509-468-4900
Fax Number :
Provider Business Practice Location Address
First Line : 310 N RIVERPOINT BLVD
Second Line : STE 210C
City : SPOKANE
State : WA
Zip : 99202-1610
Country : US
Telephone Number : 509-358-7666
Fax Number : 509-358-7744
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2005
Last Update Date : 06/21/2010

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