Healthcare Provider Details

I. General information

NPI: 1508989781
Provider Name (Legal Business Name): AMIT TIWARI MS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21302 STATE ROUTE 410 E
BONNEY LAKE WA
98391-8468
US

IV. Provider business mailing address

13107 100TH AVENUE CT E APT # O-103
PUYALLUP WA
98373-9431
US

V. Phone/Fax

Practice location:
  • Phone: 253-862-2822
  • Fax:
Mailing address:
  • Phone: 210-365-4850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00061964
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: