Provider Information for 1053489062
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NORTHWEST MEDICAL SPECIALTIES PHARMACY
Organization Subpart: NO
NPI: 1053489062
Last Updated: 2020-08-22
Certification Date:
Certification Date:
Details
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NPI | 1053489062 | ||||||||
Enumeration Date | 2006-11-30 | ||||||||
NPI Type | NPI-2 Organization | ||||||||
Status | Active | ||||||||
Authorized Official Information | Name: BARBARA DERRY Title: Administrator Phone: 2534288700 | ||||||||
Mailing Address | 1624 S I ST SUITE 305 TACOMA, WA 98405-5016 United States Phone: 253-428-8700 | Fax: | ||||||||
Primary Practice Address | 1624 S I ST SUITE 305 TACOMA, WA 98405-5016 United States Phone: 253-428-8700 | Fax: | ||||||||
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