Healthcare Provider Details

I. General information

NPI: 1255621884
Provider Name (Legal Business Name): JON ERIK DELKA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2011
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 5TH ST
CLARKSTON WA
99403-1860
US

IV. Provider business mailing address

301 5TH ST
CLARKSTON WA
99403-1860
US

V. Phone/Fax

Practice location:
  • Phone: 509-758-8897
  • Fax: 509-751-9025
Mailing address:
  • Phone: 509-758-8897
  • Fax: 509-751-9025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00044147
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH00044147
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: