Healthcare Provider Details

I. General information

NPI: 1235379637
Provider Name (Legal Business Name): FABIANO CARVALHO SANSAO PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2009
Last Update Date: 12/25/2025
Certification Date: 12/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 E MAIN ST
OTHELLO WA
99344-1578
US

IV. Provider business mailing address

10213 8TH AVE SW
SEATTLE WA
98146-1403
US

V. Phone/Fax

Practice location:
  • Phone: 509-488-9324
  • Fax:
Mailing address:
  • Phone: 206-313-8673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60026230
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: