Healthcare Provider Details

I. General information

NPI: 1023562360
Provider Name (Legal Business Name): JACE DOUGLAS HOVDA PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4840 BORGEN BLVD NW
GIG HARBOR WA
98332-6826
US

IV. Provider business mailing address

4902 WILLOW LN NW
GIG HARBOR WA
98335-8113
US

V. Phone/Fax

Practice location:
  • Phone: 253-853-9340
  • Fax:
Mailing address:
  • Phone: 509-995-6839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60651349
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: