Healthcare Provider Details

I. General information

NPI: 1922523810
Provider Name (Legal Business Name): TALAYEH KHOSHAB PHARM. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2017
Last Update Date: 08/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 S MILDRED ST
TACOMA WA
98465-1608
US

IV. Provider business mailing address

3633 MARKET PL W APT 205
UNIVERSITY PLACE WA
98466-4491
US

V. Phone/Fax

Practice location:
  • Phone: 253-460-9599
  • Fax:
Mailing address:
  • Phone: 585-290-8454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number60763875
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: