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Provider Information for 1053489062


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NORTHWEST MEDICAL SPECIALTIES PHARMACY

Organization Subpart: NO

NPI: 1053489062
Last Updated: 2020-08-22
Certification Date:

Details

NameValue
NPI1053489062
Enumeration Date2006-11-30
NPI TypeNPI-2 Organization
StatusActive
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:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 3336C0002X - Pharmacy - Clinic PharmacyWAPF00056036