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NPI Code Detail

MEDICARE: JAY S WIRAWAN PHARM.D.

MEDICARE: JAY S WIRAWAN PHARM.D.
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
1183500000XPharmacistPH60172344WA

General Provider Information

NPI Number : 1659663474
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAY S WIRAWAN PHARM.D.
Provider Business Mailing Address
First Line : 2100 S 260TH ST
Second Line : APT M302
City : DES MOINES
State : WA
Zip : 98198-9045
Country : US
Telephone Number : 206-953-3893
Fax Number :
Provider Business Practice Location Address
First Line : 105 WASHINGTON AVE N
Second Line :
City : KENT
State : WA
Zip : 98032-4438
Country : US
Telephone Number : 253-373-0156
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2011
Last Update Date : 05/12/2011

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Directions to “ JAY S WIRAWAN PHARM.D.” Practice Location

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