MEDICARE: DR. MARK TODD UNDERWOOD PHARMD

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
1	1835P1300X	Psychiatric Pharmacist	PH00018191	WA

General Provider Information

NPI Number	:	1619974995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK TODD UNDERWOOD PHARMD

Provider Business Mailing Address
First Line	:	5235 RAY NASH DR NW
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-5975
Country	:	US
Telephone Number	:	253-265-8611
Fax Number	:	253-265-8272

Provider Business Practice Location Address
First Line	:	9601 STEILACOOM BLVD SW
Second Line	:	PHARMACY SERVICES
City	:	TACOMA
State	:	WA
Zip	:	98498-7213
Country	:	US
Telephone Number	:	253-761-3390
Fax Number	:	253-756-2707

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	03/10/2010

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