Healthcare Provider Details

I. General information

NPI: 1407406028
Provider Name (Legal Business Name): ERIC J ALONZO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9998 DANCING LASSO CT
LAS VEGAS NV
89178-7545
US

IV. Provider business mailing address

11728 SE 228TH PL
KENT WA
98031-3708
US

V. Phone/Fax

Practice location:
  • Phone: 253-777-5973
  • Fax:
Mailing address:
  • Phone: 253-777-5973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number22882
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number60937049
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number91783
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: